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special attention is called to the following: 

The next Annual Meeting of the Medical Society 
OF New Jersey will be held at Allenhurst, on the 
25th, 26th, and 27th of June, 1901. 

Each District Society is entitled to three Delegates at 
large and one additional delegate for every ten members. 

The District Reporters are requested to send their 
reports to the Chairman of the Standing Committee 
at least two weeks before the time of the Annual 
Meeting. 

The Standing Committee would remind Reporters 
that their reports are published in the volume of 
Transactions, and should therefore be carefully prepared, 
and that names and medical terms especially should be 
distinctly written. Reports from other physicians 
should be incorporated in their own report. 

The Secretaries of the respective societies are 
requested to send a list of the Annual Delegates and of 
Active Members in regular standing, with the post-office 
addresses, to the Recording Secretary, Dr. Wm. J. 
Chandler, South Orange, at least ten days before the 
Annual Meeting. 

The assessment upon the District Societies for the 
year ending June, 1901, is $2.00 for each member. 



TRANSACTIONS 



OF THE 



Medical Society 



OF 



NEW JERSEY. 



1900. 



/.. J. Hardkam, Printer. 243 6^ 245 Market Street, Newark^ N. f. 

1900. 



OFFICERS, 1900 



PRESIDENT. 

WILLIAM PlERSOiN,* Orange 



J. D. McGILL, . I .j^j^ p \^m V J^^s^^ ^^^^ 
E. L. B. GODFREyV . .^^ J . Camden 

HENRY MITCHELL^S^ ^ H..lBL #<^ Asbury Park 

CORRESPONDING SECRETARY, 

E. W. HEDGES, Plainfield 

RECORDING SECRETARY, 

WILLIAM J. CHANDLER, South Orange 

TREASURER. 

ARCHIBALD MERCER, .... Newark 



HENRY W. ELMER, ^'j^f^^-^^'', u 0*? ^1 Bridgeton 
B. A. WADDlNGTQjN, . *. \^ I. Salem 



DOWLING BENJAMIN, Camden 

CHARLES YOUNG, Newark 

TERM EXPIRES I903. 

G. H. BALLERAY, Paterson 

WM. H. McGEE, ^ Belvidere 



•Died June la, 1900. 




FELLOWS. 



All persons who shall have been, ot may hereafter be President of the Society, shall rank as 
Fellows, and be entitled to all the privileges of delegated members. 

Act of Incorporation^ Sec. i. 
The dates represent the y^ of election as President. 
Those marked thus (*) are d6eease4'.' • , - • 



♦Robert McKean .1766 

♦William Burnett 1767 

♦John Cochr.vn 1768 

♦Nathaniel Scudder 1770 

♦Isaac Smith 1771 

♦James Newell , . 1772 

♦Absalom Bainbridge. ...1773 

♦Thomas Wiggins 1774 

♦Hezekiah Stites 1775 

I* T* *!• 1* T* 

♦John Beatty 1782 

♦Thomas Barber 1783 

♦Lawrence Van U«rveer.i784 

♦Moses Bloomfield 1785 

♦William Burnett. ..... 1786 

♦Jonathan Elmer.. 1 787 

♦James Stratton. 1788 



♦Charles Smith 

♦Matt. H. Williamson. 

♦Samuel Forman 

♦John Van Cleve 

♦Lewis Dunham 

♦Peter L Stryker 

♦John Van Cleve 

♦Lewis Condict 

*James Lee 

♦William G. Reynolds. 
♦Augustus R. Taylor.. 

♦William B. Ewing 

♦Peter I. Stryker 

♦Gilbert S. Woodhull. 
♦Wm. D. McKissACK .... 

♦Isaac Pi erson 

♦Jeptha B. Munn 

♦John W. Craig 



♦Moses Scott 1 789 

♦John Griffith 1790 ♦Augustus R. Taylor. 

♦Lewis Dunham 1791 ♦Thomas Yarrow 

♦Isaac Harris 1792 

♦Elisha Newell 1795 

♦Jonathan F. Morris . . . . i 807 

♦Peter I. Stryker 1808 

♦Lewis Morgan 1809 

♦Lewis Condict 1810 



*FiTz Randolph Smith. 
♦William Forman 



♦Samuel Hayes 

♦Abm. P. Hageman 

♦Henry Van Derveer. . 
♦Lyndon A. Smith... .. 



811 
812 
814 

815 
816 

817 
818 

819 

820 

821 

822 

823 
824 

825 

826 

827 

828 

829 

830 

831 
832 

833 

834 

835 
836 

837 



MIDICAL SOCIETY OF NEW JERSEY. 



♦Benj. H. Straiton 

♦JABEZ G. GOBLE 

♦Thomas P. Stewart 

♦Ferdinand S. Schenck.. 

♦Zachariah Read. 

♦Abraham Skillman 

♦George R. Chetwood. . . 

♦Robert S. Smith 

♦Charles Hannah 

♦Jacob T. B. Skillman 

♦Samuel H. Pennington. 

♦Joseph Fithian 

♦Elias J. Marsh 

♦John H Phillips 

♦0th n'l H. Taylor 

♦Samuel Lilly 

♦A. B. Dayton 

♦J. B. Coleman 

♦Richard M. Cooper 

♦Thomas Ryerson 

♦Isaac P. Coleman 

♦John R. Sickler 

♦Wm. Elmer 

♦Jno. Blane 

♦JNO. Woolverton 

♦Theo. R. Varick 

♦Ezra M. Hunt 

♦Abram Coles 

♦Benjamin R. Bateman.. . 

jNO. C. Johnson . 

♦Thomas J. Corsun 



838 ♦William Pierson ...1869 

839 *Thomas F. Cullen. , 1870 

840 ♦Charles Hasbrouck 1871 

841 Franklin Gauntt 1872 

842 *T. J. Thomason 1873 

843 *G. H. Larison 1874 

844 ♦Wm. O'Gorman 1875 

845 *jNO. V. Schenck 1876 

846 Henry R. Baldwin 1877 

847 *JOHN S. Cook 1878 

848 Alex. W. Rogers 1879 

849 *Alex. N. Dougherty 1880 

850 *Lewis W. Oakley 1881 

851 ♦John W. Snowden 1882 

852 ♦Stephen Wickes 1883 

853 P. C. Barker 1884 

854 ♦Joseph Parrish 1885 

855 Charles J. Kipp 1886 

856 John W. Ward 1887 

857 H. Genet Taylor 1888 

858 *B. A. Watson 1889 

859 ♦Jas. S.Green 1890 

860 Elias J. Marsh 1891 

861 George T. Welch 1892 

862 John G. Ryerson 1983 

863 O. H. Sproul 1894 

864 William Elmer 1895 

865 T. J. Smith 1896 

866 David C. English .... 1897 

867 C. R. P. Fisher 1898 

868 Luther M. Halsey 1899 



HONORARY MEMBERS. 



-• m 9 



*David Hosack, New York 1827 

*J. W. Francis 1827 

♦John Condict, Orange 1830 

♦Usher Parsons, Rhode Island 1 839 

♦Reuben D. Murphy, Cincinnati 1839 

♦Alban G. Smith. New York 1 839 

♦WiLLARD Parker, New York 1842 

♦Valentine Mott, New York 1843 

♦Jonathan Knight. New Haven 1848 

♦Nathaniel Chapman, Philadelphia 1849 

♦Alexander H. Stephens, New York 1848 

♦John C. Warren, Bo^^ton 1849 

♦Lewis C. Beck, New York 1850 

♦John C. Torrey. New York 1850 

♦George B. Wood, Philadelphia. 1853 

H. A. BUTTOLPH, Short Hills, N. J 1854 

♦ASHBEL Woodward, Franklin, Conn 1861 

♦Thomas W. Blatchford, Troy, N. Y 1886 

♦Jeremiah S. English, Manalapan, N. J 1867 

♦Stephen Wickes, Orange, N. J 1868 

♦S. O. Vanderpool, Albany, N. Y 1872 

♦Joseph Parrish. Burlington, N. J 1872 

♦Ferris Jacobs, Delhi, N. Y 1872 

C A. LiNDSLEY, New Haven, Conn 1872 

Wm. Pepper, Philadelphia ,1 874 

S. WiER Mitchell, Philadelphia 1876 

Cyrus F. Brackett, Princeton, N. J 1880 

♦Joseph C. Hutchinson, Brooklyn. N. Y 1880 

Thomas Addis Emmett, New York 1884 

♦Isaac E. Taylor. New York 1884 

♦D. Hayes Agnew. Philadelphia 1886 

♦Jos. Leidy, Philadelphia 1886 

Frederick S. Dennis, New York 1893 

♦John H. Ripley. New York 1893 

Virgil P. Gibney, New York 1893 

♦William Pierson, Orange, N. J 1894 

Abram Jacobi, New York 1896 

♦Virgil M. D. Marcy, Cape May City 1896 

♦Samuel H. Pennington. Newark, N. J 1897 



PERMANENT DELEGATES. 



Atlantic— Theo. H. Boysen, Egg Harbor City. 

B. C. Pennington, Atlantic City 

W. B. Stewart, Atlantic City 

Bergen— Henry C. Neer, Park Ridge 

Daniel A. Currie, Englewood 

David St. John, Hackensack 

Burlington J. Howard Pugh, Burlington. . 

N. Newlin Stokes, Moorestown 

A. W. Taylor, Beverly 

Camden— Alexander Marcy, Riverton 

James M. Ridge, Camden 

Duncan W. Blake. Gloucester 

Onan B. Gross, Camden 

William H. Ireland. Camden . 

Daniel Strock, Camden 

William H. Iszard, Camden 

William A. Davis, Camden 

Cape May — Randolph Marshall, Tuckahoe.. 

Cumberland — W. H. C. Smith, Millville 

S. T. Day, Port Norris 

M. K. Elmer. Bridgeton 

T. J. Smith, Bridgeton 

O. H. Adams, Vineland 

Essex— Arthur Ward, Newark 

Charles Young, Newark 

Joseph C. Young, Newark. 

George B ayles, Orange 

Herman C. Bleyle, Newark 

William J. Chandler, South Orange. . . 

Edward J. Ill, Newark 

George R. Kent, Newark 

Daniel M. Skinner, Belleville 

Charles H. Bailey, Bloomfield 

Thomas S. Fitch, Orange , 



896 
900 
900 
928 

899 
900 
892 
895 
898 
892 
892 

89s 
895 

895 

899 
899 
900 
899 
892 
899 
900 
900 
900 
892 
892 
892 
896 
896 
896 
896 
896 
896 
898 
898 



MEDICAL SOCIETY OF NEW JERSEY. 



Essex— Richard C. Newton, Montclair 

Joseph D. Osborne, Newark 

William Rankin. Newark 

Joshua vv. Read, Newark 

George A. Van Wagenen, Newark 

James T. Wrightson, Newark 

Peter V. P. Hewlett, Newark 

Theron Y. Sutphen, Newark 

Charles F. Underwood, Newark 

L. Eugene Hollister, Newark 

Charles D. Bennett, Newark 

Henry B. Whitehorne, Verona 

William B. Graves, East Orange 

Robert G. Stanwood, Newark 

Gloucester— George E. Reading, Woodbury 

George C. Laws, Paulsboro 

James Hunter, Jr., Westville 

Hudson — J. D. McGill, Jersey City 

Romeo F. Chabfrt, Hoboken 

J. A. EXTON, Arlington 

Jos. M. Rector, Jersey City 

Frederick M. Corwin, Bayonne 

Geo. E. McLaughlin, Jersey City 

Mortimer Lampson, Jersey City 

T. R. Chambers, Jersey City 

Hunterdon — Isaac S. Cramer, Flemington 

W. S. Creveling, Valley 

Nathaniel B. Boileau, Jutland 

Mercer— Corn KH us Shkpherd, Trenton 

R. R. Rogers, Sr , Trenton 

David Warman, Trenton 

Elmer Barwis, Trenton 

Thos. H. Mackenzie, Trenton 

C. F. Adams, Trenton 

J. C. Felty, Trenton 

Middlesex— Edward B. Dana, Metuchen 

Ambrose Treganowan, South Amboy 
Charles H. Voorhees. New Brunswick 
F. M. Donahue, New Brunswick 



  • 



898 
898 
898 
898 
898 
898 
900 
900 
900 
900 
900 
900 
900 
900 

893 

895 

898 
892 
892 
898 
900 
900 
900 
900 
900 
892 
896 
899 
892 
895 
897 
898 
900 
900 
900 
898 
898 
899 
900 



lO 



MEDICAL SOCIETY OF NEW JERSEY. 



Monmouth— Henry C. Cooke, New Brunswick 

Henry Mitchell, Asbury Park 

Morris— I. W. CONDiCT, Dover 

John Stiger, Mendham 

Levi Farrow, Middle Valley 

CUTHBERT WiGG. Boonton 

Passaic— W. B. Johnson, Paterson 

P. A. Harris, Paterson 

George H. Balleray, Paterson 

John L. Leal, Paterson 

W. K. Newton. Paterson . 

Calvin Terri berry, Paterson 

C. H. Scribner, Paterson 

ROBT. M. CURTS. Paterson 

James M. Stewart, Paterson 

John T. Gillson, Paterson 

Matthew A. Mackintosh, Paterson 

Salem — B. A. Waddington, Salem 

F. Bilderback, Salem 

W. H. James, Pennsville 

Henry Chavanne. Salem 

Somerset— H. G. Wagoner, Somerville 

S. O. B. Taylor, Millstone 

J. P. Hecht, Raritan 

A. L. Stillwell, Somerville 

Sussex— Sidney B. Straley, Andover 

E. Morrison, Newton 

B. W. Ferguson, Beemerville 

Union— Alonzo Pettit, Elizabeth 

E. B Silvers, Rahway 

J. Ackerman Coles. Scotch Plains 

T. H. TOMLiNSON, Plainfield 

T. N. McLean, Elizabeth 

James S. Green, Elizabeth 

N. L. Wilson, Elizabeth 

W. U. Selover, Rahway 

Warren— William H. McGee, Belvidere , 

Alva C. Van Syckle, Hackettstown . . . . 



892 
892 
892 
892 
1895 
899 
892 

893 
896 

899 
899 

899 

900 

900 

900 

900 

900 

893 
899 

900 

900 

892 

897 

898 

900 

899 

899 

899 

893 

893 
896 

896 

898 

900 

900 

900 

896 

899 



Members of District Medical Societies 

REPRESENTED AT THE 

ANNUAL MEETING. 1900. 



ATLANTIC COUNTY. 

District Society organized June 7, 1880. Annual meeting first week in February. 

Walter Reynolds, Pres., E. H. Madden, Absecon 

Atlantic City Philip Marvel, Atlantic City 

T. H. Boysen, V.-Pr^s., H. D. Nichols, 

£g^ Harbor City James North, '* 

Wm. E. Darnall, Secy <&- Treas., B. C. Pennington, *' 

Atlantic City W. M. Pollard, 

Emery Marvel. Pep.. " W. M. Powell, 

W. M. Barnes, •* Eugene L. Reed, 

E. C. Chew, " Thos. K. Reed, 

A. D. Cuskaden, " Talbot Reed, 

J. M. Elmer, Eg^ Harbor City Edward A. Reiley, " 

W. B. Fayerman, Atlantic City Theodore Senseman, *' 

C. M. Fish, " E. S. Sharpe, 

C. Garrabrant, " A. B. Shimer, 

G. R. Gehring, Bakersville L. R. Souder, 

W. M. Hodges. •• J. W. Snowball, 

E. E. Howard, Atlantic City W. B. Stewart, 

H. C. James, May's Landing M. L. Somers, 

C. R. Johnson, Atlantic City J. B. Thompson, 

J. Addison Joy, " E Bart. Webster, 

No. members. 37. 

BERCEN COUNTY. 

District Society reorganized February 28, 1854. Annual meeting second Tuesday in April. 

Howard McFadden. Pres., David St. John, Treas , 

Hackensack Hackensack 

Chas. Calhoun. V.-Pres,, J. W. Proctor, Rep., Englewood 

Rutherford Sam'l E. Armstrong. Rutherford 

Daniel A. Currie, Secy, Englewood M. S. Ayres, Fairview 



12 



MEDICAL SOCIETY OF NEW JERSEY. 



H. M. Banks, Englewood 

Chas. D. Brooks, Hackensack 
M. Blinckston. Westwood 

E. E. Qox\o\tr,Hasbrouck Heights 
Edgar K. Conrad, Hackensack 
J. F. Demund, Ridgewood 

H. C. Elsing. Ridgefield Park 
Geo. Bancroft Gale, Rutherford 



L. B. Parsell. 

J. E. Pratt. 

B. D. Stone, 

A. A. Swayze, 

J. W. Terry. 

A. L. Vandewater, 

Myron Van Horn. 



Closter 

Sch raalenburgh 

Westwood 

Hackensack 

Englewood 

Hackensack 

Englewood 

Rids^ewood 



T. N. Gregory, 
John J. Haring, 
Joseph Huger, 
Fred. F. Hallett. 
Eugene Jehl, 
J. B. W. Lansing, 
H. C. Neer, 

No. members, 36. 



Englewood 

Tenafty 

Fort Lee 

Hackensack 

Park Ridge 

Tenafty 

Park Ridge 



William L. Vroom, 

Carrie H. Van Horn. Englewood 

J. A. Wells, 

J. Talmage Wyckoff, Leona 

Max W>ler, Fort Lee 

F. H. White, Hackensack 

Samuel J. Zabriskie, Westwood 



BURLINGTON COUNTY. 



Society organized May 19, 1829. Meets third Tuesday in January, April, June and 
October. Annual meeting second Tuesday in April 



F. S, Janney, Pres., Riverton Franklin Gauntt, 

Wm. P. Melcher, V.-Pres., F. A. Gauntt, 

Mount Holly Jacob C. Haines, 
A. W\ Taylor, Secy, Beverly Alex. Marcy, 

E. HoUingshead, Treas., 

Pemberton 
W. E. Hall. Hist., Burlington 
Joseph Stokes, Rep., Moorestown 
J. D. Janney, Censor, Cinnaminson 
Emma P. Weeks, " Riverside J. H. Pugh, 
1. W. HoUingshead, Censor, Lewis L. Sharp, 

Moorestown 
Florence 
Burlington 
Columbus 
Mount Holly 



Wm. L. Martin, 
W. C. Parry, 
R. H. Parsons, 
T. T. Price, 
Elmer D. Prickett, 



David Baird, Jr., 
John B. Cassady, 
J. E. Dubell, 
John J. Flynn, 



A. H. Small, 
W. H. Shipps, 
N. N. Stokes, 
F. G. Stroud, 
Irene D. Young, 



Bnr ling ton 

Vincentown 

Riverton 

Rancocas 

Lumber ton 

ft 

Tuckerton 

Mount Holly 

Burlington 

Mcdford 

Riverside 

Bordentown 

Moorestown 

Bordentown 



CONTRIBUTING MEMBER. 
William Martin, Bristol, Pa, 



MEDICAL SOCIKTY OF NEW JERSEY. 



HONORARY MEMBERS. 



13 



Chas. P. Noble, i6jj Locust St,, Chas. 11. Thomas, i^og Locust St., 

Philadelphia, Pa, Philadelphia, Pa. 

E. P. Townsend. Billings, Mont. 
No. members, 29. 

CAMDEN COUNTY. 

Organized August 14, 1846. Annual meeting second Tuesday in May. 



Camden 

Gloucester 

Haddonfield 

Camden 



i( 



<< 



Gloucester 
Camden 



John F. Leavitt, Pres., Camden 

Wm. R. Powell. V.-Pres., ** 

Paul M. Mecray, Secy. 

Ernest S. Ramsdell, Treas., ** 

John G. Doran, Rep., 

H. H. Sherk, Hist., 

Jos. S. Baer, 

W. G. Bailev, 

Duncan W. Blake, 

Chas. S. Braddock, 

Walters. Bray, 

Philip W. Beale, 

Dowling, Benjamin, 

John K. Bennett, 

Sylvan G. Bushey, 

Robert Casperson, 

Wm. A. Davis, 

E. E. DeGrofft,' 

Clarence B. Donges, 

John W. Donges, 

Joel W. FitKian, 

E. L. B. Godfrey, 

Onan B. Gross, 

J. J. Haley 

Levi B. Hirst, 

Conrad G. Hoell, 

Frank L. Horning, 

Jos. E. Hurff, 

Wm. H. Ireland, 

Wm. H. Iszard, 

Heney Jarrett, 



Blackwood 

Camden 

. ** 

Bii'erton 
Camden 



Cramer Hill 
Camden 



t« 



«( 



Woodstown 
Camden 



(» 



14 



tt 



t4 



Gloucester 
Camden 



<< 



(< 



Blackwood 
Camden 



<( 



<i 



Chas. H. Jennings, Merchantville 

Wm. B. Jennings, Haddonfield 

Wm. S. Jones, Camaen 

Wm. W. Kain, 

Grant E. Kirk. 

Adrinette LeFevre, 

A. H. Lippencott, 

Alexander McAlister, 

Alex. Marcy, 

Frederick W. Marcy, 

John W. Marcy, Merchantville 

Marcus K. Mines, Camden 

J. W. Martendale, 

Jos. L. Nicholson, 

Milton W. Osmun, 

Howard F. Palm, 

Wm. H. Pratt, 

Sophia Presley, 

Jas. M. Ridge, 

Frank N. Robinson, '• 

Edw. A. Y. Schellinger, 

Chas. H. Shivers, Haddonfield 

J. Anson Smith, 

John R. Stevenson, 

Daniel Stout, 

Daniel Strock, 

H. Genet Taylor, 

Wm. A. Westcott, 

Jos. H. Wills, 

W. P. Wingender, 

E. B. Woolston, Marlton 



«• 



>t 



Blackwood 

Haddonfield 

Berlin 

Camden 

Berlin 
Camden 



14 



MEDICAL SOCIETY OF NEW JERSEY. 



HONORARY MEMBERS. 

G. W. Bough man, Marshalltown J. VV. Hewlings, Moorestown 

New Castle Co,, Delaware J. G. Young, Philadelphia, Pa. 

Richard C. Dean, U, S, Navy Alexander M. Mecray, 

Chas. G. Garrison, Merchantville Maple Shade 

No. members, 62. 

CAPE MAY COUNTY. 

Society organized March 13, 1885. %feets first I'uesday in April and November. 

A. L. Leach, Pres,, Cape May L M. Downs, Court House 
J. S. Douglass, V,'Pres„ Tuckahoe Wm. A. Lake, Green Creek 
Randolph Marshall. Treas., " Joseph Marshall, Tuckahoe 
C. B. Corson, Sec'y &* Pep., James Mecray, 

South Seaville Emlen Physic, 

B. T. Abbott. Censor, Ocean City Eugene Way. 
W. S. Learning. *' Cape May J. Way, Cape May Court House 
V. M. D. Marcey, '* • W. R. Wales. Cape May 
N. A Cohen, Wildwood 

HONORARY MEMBERS. 

Chas. M. Gandy, U. S. Army Jonathan Learning, 

Coleman Leaming, Cape May Court House 

Cape May Court House J. H. Ingram, China 

No. members, 16. 

CUMBERLAND COUNTY. 

Society organized December 8, 1818 Annual meeting second Tuesday in April. 

F. M. Bateman. Pres., Cedarville Lester Hummell, Greenwich 



Cape May 
Dennisville 



H. G. Miller, V.-Pres., Millville C. L. Marker. 
J. C. Applegate, Secy, Bridgeton A. R. Judson, 
Jos. Tomlinson, Treas., 
L. L. Hand, Rep., 



O. H. Adams, 
N. H. Burt, 
Samuel Bennett, 
Alfred Cornwell, 
C. B. Cunningham, 
T. G. Davis, 
G. E. Day, 
S. T. Day, 
H. W. Elmer, 
M. K. Elmer, 
Edward Fogg, 



W. L. Newell, 

Leesburg D. H. Oliver, 

Vineland L. B. Phillips, 

Fair ton W. F. Sawyer. 

Millville Jos. Sheppard, 

Bridgeton T. J. Smith. 

Vineland W. H. C. Smith, 

Bridgeton S. M. Snyder, 

Millville Ellsmore Stites, 

Port Norris J. R. C. Thompson, 

Bridgeton J. W. Wade, 
C. W. Wilson, 
Shiloh 



Port Norris 

New Port 

Millville 

Bridgeton 

Deerfield 

Vineland 

Bridgeton 

Millville 

Greenwich 

Bridgeton 

Bridgeton 

Millville 

Vineland 



MEDICAL SOCIETY OF NEW JERSEY. 1 5 

ASSOCIATE MEMBERS. 

W. E. Ashton, Philadelphia, Pa, W. W. Keen, Philadelphia, Pa, 
J. M. Barten, - •* Chas. P. Noble, 



(( i< 



J. Chalmers DaCosta. •* *' Chas. O. Oliver, 

B. C. Hirst. " " David Reisman, 



«< «c 



«« 



«• 



H. A. Hare, 

HONORARY MEMBER. 

Ephraim Bate man, Cedarville, 
No. members, 31. 

ESSEX COUNTY. 

Society organized June 8, 1816. Annual meeting first Tuesday in April. 

Thos. W. Harvey, Pres., Orange J. Henry Clark, Newark 

Aai-on K. Baldwin, V.-Pfes., Henry L. Coit, 

Newark Horace C. Cory, 

Archibald Mercer, Secy, ** Theodore W. Corwin, 

Chas. D. Bennett, Treas., *' Wm. H. K. Davis, East Orange 

William S. Disbrow, Rep., " John Dennis. Newark 

Maurice Asher, " Richard G. P. Dieffenbach, •* 

Charles H. Bailey, Bloomfield Daniel M. Dili, 

Samuel H. Baldwin, Newark Walter Dodge, Orange 

George Bayles, Orange Arthur C. Dougherty, Newark 

Frederick W. Becker, Newark Winfield S. DeVausney, 

Arthur W. Bingham, E, Orange Frank Devlin, 

Hermann C. BleyJe, Newark Wells P. Eagleton, 

John H. Bradshaw, Orange Thomas P. Edwards, 

Rudolph Braun, Newark Julius Egge, 

William M. Brien, Orange Valley David E. English, Milburn 

James S. Brown, Montclair James R. English, Irvington 

William Buermann, Newark Joseph Fewsmith, Newark 

Edwin L. Burns, •* Thomas S. Fitch, Orange 

Robert L. Burrage, East Orange Richard P. Francis, Montclair 

Charles N. BQttner, Orange R. D. Freeman, South Orange 

Charles V. Burke, Newark Albert Frey, Newark 

William E. Carroll, - William Gauch, 

Douglas A. Cater, Orange Isabel M. Geddes, 

William J. Chandler, So. Orange Robert F. Gillin, 

Albion C. Christian, Irvington Herman A. Glatzmayer, 



<i 



<< 



<> 



(« 



<t 



It 



i6 



MEDICAL SOCIETY OF NEW JERSEY. 



4« 



<< 



William M. Goodwin, Newark 

William B. Graves, East Orange 

Thomas N. Gray, " 

Chauncey B. Griffiths. Newark 

Solomon Greenbaum, 

Frank D. Garrison, So, Orange 

Joseph F. Hager, Newark 

John F. Hagerty, '* 

Frederick W. Hagney, ** 

Eleanor Haines, 

Edward H. Hamill, 

E. Zeh Hawkes, 

Joseph H. Haydon, 

John Hemsath, '* 

Henry T. Herold, 

Herman C. H. Herold, 

Peter V. P. Hewlett. ' " 

Livingston S. Hinckley, *• 

Edgar Holden, 

L. Eugene HoUistcr, 

Charles L. Ill, 

Edward J. Ill, 

Frederick C. Jacobson, •* 

Jotham C. Johnson, 

William A. Judson, 

George R. Kent, '* 

Charles J. Kipp, 

J. M. W. Kitchen, East Orange 

Francis E. Knowles, So, Orange 

Henry A. Kornemann, Newark 

Stephen G. Lee, Orange 

Marie L. Lefort, Newark 

Charles Lehlbach, 

Jesse D. Lippincott, •' 

Frank W. Lockwood, E. Orange 

Herbert W. Long, Newark 

Thomas W. Loweree, " 

Calista V. Luther, So, Orange 

Henry D. McCormick, Verona 



Floy McEwen, Newark 
William H. McKenzic, 

James M. Maghee, Orange 

William W. Martland. Newark 

Henry E. Matthews, Orange 

Sarah R. Mead, Newark 

Frank B. Meeker, '* 

Pancrazio M. Megaro, ** 

Andrew M. Mills, *' 
W. D. Mitchell, East Orange 

Clement Morris, Ne^vark 
Frederick C. Nadler, 
Albert B Nash, 

Emanuel Newman, " 

Richard C. Newton, Moniclair 

Henry W. Nolte, Newark 

William M. O'Reilly, Orange 

Joseph D. Osborne, Newark 

William Pennington, Irvington 

Edward D. Phelan, Newark 

George B. Philhower, Nutley 

William Pierson. Orange 
Daniel W. Poor, East Orange 

Katherine Porter, Orange 

Robert C. Potter Newark 
John M. Rand, . 
Charles D. Randall, 
William Rankin, 
Joshua W. Read. 
Robert C. Ribbans, 
Edward M. Richman, 
Philip Ricord, 
Samuel E. Robertson, 

Benjamin A. Robinson, ** 

Manning W. Robinson, " 
Wm. D. Robinson, East Orange 

Hugh P. Roden, Newark 
William J. Roeber, 
George A. Rogers, 



(t 



«i 



it 



K 



MEDICAL SOCIETY OF NEW JERSEY. 



17 



George W. Rolerfort, Newark M. H. Cash Vail, Vailsburg 

Medford Runyon, South Orange Geo. A. Van Wagenen, Newark 



Wm. H. SchopCer, 


Newark 


Elbert S. Sherman, 




Charles A. Schureman, 




Emanuel Schwartz, 




Edward Sealy, 




William F. Seidler. 




Marco Seidman, 




William F. Shick, 




M. Herbert Simmons, 


Orange 


Daniel M. Skinner, 


Belleville 


Anna L. Smith, 


Montclair 


D. Winans Smith, 


Newark 


Joseph F. Somerhof, 




Edward Staehlin, 




Robert G. Stanwood, 




Robert M. Sutphen, 




Theron Y. Sutphen, 




Charles E. Teeter, 




J. Francis E. Tetreault, 


Orange 


Frederick W. Thum, 


Newark 


Charles Titus, 


<« 


Henry A. Towle, 


<t 


Sidney A. Twinch, 


K 


Charles F. Underwood, 


t( 


Herbert B. Vail, 


Belleville 



Orange 
Newark 



«( 



<< 



If 



Bloomfield 
Newark 



(( 



<< 



<( 



Newark 



Maria M. Vimton, 

George N. Wait, 

David L. Wallace, 

Henry J. F. Wallhauser, 

Arthur Ward, 

Aaron C. Ward, 

Edwin M. Ward, 

Leslie D. Ward, 

William S. Ward, 

William H. Warren, 

Walter S. Washington, 

Frederick Webner, 

Lars L Wendleboe, " 

Edward H. White, 

William H. White, Bloomfield 

Henry B. Whitehornc, Verona 

Albert Wickman, 

W. Stockton Wilson, 

Henry M. Woolman, 

Edward E. Worl, 

James A. Wormley, 

James T. Wrightson, 

Charles Young, 

Joseph C. Young, 

Charles M. Zeh, 

HONORARY MEMBER. 
Thomas Dunn English, Newark, 
No. members, 183. 

GLOUCESTER COUNTY. 

Society organized December, z8i8. Annual meeting third Thursday in January. 

Eugene Z.Hillegass,/'r^j.,il/^«//^<i L. M. Halsey, Censor ^ 
Samuel F. Stanger, V.-Pres., Williamstown 

Harrisonville J as. Hunter, Jr., Censor y Westville 

Geo. E. Reading, Secy 6t* Treas., Harry A. Stout, Censor, Wenonah 

Woodbury Samuel F. Ashcraft, Mullica Hill 

Will. Brewer, Rep,, *' Geo. W. Bailey, IVenonah 

2 



it 



it 



II 



«« 



«i 



M 



II 



i8 



MEDICAL SOCIETY OF NEW JERSEY. 



Ralph £. Buck, 

Charles M. Burk, 

Henry C. Clark, 

Henry B. Diverty, 

E. M. Duffield. 

J. Gaunt Edwards, Williamstown 

C. Frank Fisler, Clayton 

T. Franklin Giflford, Woodbury 

Chas. S. Heritage, Olassboro 



Niwfield 

Clarksboro 

Woodbury 
<< 

Glassboro 



Jos. M. Husted, 
Geo. C. Laws, 
Eugene T. Oliphant. 
Cyrus B. Phillips, 
Albert Porch, 
P. E. Stilwagon, 
Wm. A. Stratton, 
B. A. Waddington, 
Howard A. Wilson, 



Clayton 

Paulsboro 

Bridgeport 

Hurfville 

Clayton 

Bridgeport 

Woodbury 

Salem 

Woodbury 



HONORARY MEMBERS. 

Judson Daland, Philadelphia William H. Iszard, Camden 

E. E. DeGrofft, Camden Mordecai Price, Philadelphia 

Hobart A. Hare, Philadelphia Charles S. Turnbull, 

No. members, 27. 



<4 



HUDSON COUNTY. 

Society organi/.ed October i, 185 1. Annual meeting first Tuesday in May. 



John C. Parsons, Pres., 

, Jersey City 
Charles H. Purdy, Secy, 
Henry H. Brinkerhoff, 7>v<?j., 

Jersey City 
H. H. Burnelte, Rep,, Hoboken 



Henry AUers, 
Ulamer Allen, 
£. Mills Baker, 
John J, Bauman, 
H. J. Bogardus, 
N. G. Bozeman, 
Edward P. Buffett, 
John J. Broderick, 
Edward L. Bull, 
Oliver R. Blanchard, 
Frank F. Bowyer, 



Harrison 
Jersey City 



t < 



(( 



(( 



<< 



Talbot R. Chambers, Jersey City 

Charles W. Cropper, 

S. Herbert Culver, 

Romeo F. Chabert, Hoboken 

Frederick M. Corwin, Bayonne 

Gordan K. Dickinson, y^rj^ City 

Florence De Hart, *' 

R. H. Dinglestedt, 

Edwin K. Dunkle, 

Lucius F. Donohue, 

Alexander Dallas. 

Benjamin Edge, 

John R. Everitt, 

James A. Exton, 

John Faber, 

Joseph F. Finn, 

William F. Faison, 



Hoboken 

Jersey City 

Bayonne 

<i 

Jersey City 
<< 

Arlington 
Jersey City 



J. G. Lewis Borgmeyer, Bayonne N. Frederick Feury, 
Burdette P. Craig, Jersey City William Friele, 
John E. Corrigan, ** Howard S. Forman, 



MEDICAL SOCIETY OF NEW JERSEY. 



19 



4t 



(( 



Archibald C. Forman, Bayonne 
Geo. D. Fyfe, Jersey City 

Leonard J. Gordan, 
Frank D. Gray, 
Charles A. Gilchrist, Hoboken 
John P. Henry, Jersey City 

Christopher D. Hill, 
Peter Hoffman, 
William L. Hetherington. " 
Edward P. Hart. 
Samuel A. Heifer, 
Roy Inglis, 
Calvin F. Kyte, 
A. J. Kirsten. 
Chas. K. Law, 
Henry H. Lynch, 
Mortimer Lampson, 
F. E. Lambert, 
John D. McGill. 
George E. McLaughlin, 
John J. McLean, 
No. members. 80. 



Jersey City 



<( 



«( 



«( 



Bayonne 
Jersey City 



Hoboken 
Jersey City 



<< 



<4 



t< 



<< 



(< 



i< 



Frank W. Mallalieu, Jersey City 

Edward G. Marks, Arlington 

John Nevin, 

William J. Parker, 

Imanuel Pyle, 

Wallace Pyle, 

Walter Pocock, 

Joseph M. Rector, 

Frederick C. Robertson, " 

Henry B. Rue, Hoboken 

Joseph H. Rosenkranz, " 

Geo. W. Shera, Jersey City 

Henry Spence, 

Robert Stewart, 

George H. Sexsmith, Bayonne 

H. Melville Smith, South Orange 

Hamilton Vreeland, Jersey City 

Conrad Wienges, " 

William Perry Watson, 

John E. West, 

Joseph Wolfson, **- 



(( 



It 



HUNTERDON COUNTY. 

Society organized June 12, 1891. Annual meeting fourth Tuesday in ApriH 

E. H. Moore, Pres., White House Theo. B. Fulper, Glen Gardner 

O. H. Sproul, Sec'y, Fleming ton, Frank Grim, 

L S. Cramer, Treas., " F. L. Johnson, 

Theo. W. Bebout, M. D. Knight, 

Stirling, Morris Co, F. W. Larison, 



Geo. N. Best, 
N. B. Boileau, 
W. S. Creveling, 
E. W. Closson, 
J. H. Ewing, 



Rosemont E. D. Leidy, 

Jutland A. B. Nash. 

Valley Geo. L. Romine, 

Lambertville Geo. W. Bartow, 

Flemington Howard Scrvis, 

HONORARY MEMBERS. 

Mathias Abel, Providence, R. L W. D. Wolverton, 
H. P. Loomis, New York City U. S. Army, Retired 

No. members, 19. 



Baptistown 

Stanton 

Clinton 

Lambertville 

Flemington 

Frenchtown 

Lambertville 

Three Bridges 

Junction 



20 



MEDICAL SOCIETY OF NEW JERSEY. 



MERCER COUNTY. 

Society organized May 23, 1848. Annual meeting second Tuesday in May. 



Geo. N. J. Sommer, Pres., Trenton 
Geo. H. Parker, V.-Ptes., 
Alexander Armstrong, Secy^ ** 
Ira M. Shepherd, Treas., '* 
Geo. R. Moore, Rep., '* 

Chas. F. Adams, 
Chas. L. Allen, 

Elmer Barwis, ** 

Henry M. Beatty, 
Charles P. Britton, 
A. T. Bruere, 
John Bruydre, 

Wm. M. Carling, ** 

J. F. Chattin, 
W. A. Clark, 
J. C. Craythorn, 
Paul L. Cort, 
Henry B. Costill, 
A. H. Dey. 

E. L. Dickinson, '* 

P. J. Dorety. 

William Elmer, '* 

Geo. H. Franklin, 
J. C. Felty, 
S. Freeman, '* 

W. J. Hall, * 
E. S. Hawke, 

A. I. Hunt, Hamilton Square 
J. S. Jamieson. Trenton 

No. members, 58. 



Hightstown 
Trenton 



Mozart Jenkins, Trenton 

Wm. S. Lalor, 

Lyman Leavitt, 

E. K. Lee, Larenceville 

Thos. H. Mackenzie, Trenton 

Walter Madden, 

Benj. W. McGalliard, 

Chas. H. Mcllwaine, 

H. G. Norton. 

N. B. Oliphant, 

Wm. Rice, 

Elmer H. Rogers, *' 

R. R. Rogers. Sr., 

R. R. Rogers, Jr.. 

Joseph B. Shaw, " 

Cornelius Shepherd, 

W. D. Stevenson, ** 

Geo. H. Silvers, 

G. Schoening, 

Wm. McD. Struble, 

G. E. Titus, 

Irvine Turner, 

W. B. Van Duyn, 

John W. Ward, 

David Warman, 

Henry M. Weeks, 

J. H. Wikoff, 

William Wilbur, 

P. W. Yard, 



Windsor 
Trenton 

Hightstown 

Titusville 

Trenton 



li 



Princeton 

Hightstown 

Trenton 



MIDDLESEX COUNTY. 

Society organized June i6, 1816. Annual meeting third Wednesday in April. 

W. M. Moore, Pres., N.Brunswick A. L. Smith, Rep., IVe^v Brunswick 

A. C. Hunt, v.- Pres., Metuchen H. R. Baldwin. 

D. ^X^-^\\^x\%,Secy,Ne7vBrtinswic\< J. J. Bissett, Paterson 

D. C PInglish, Treas., " S. V. D. Clark, New Brunswick 



MKDICAL SOCIETY OF NEW TERSEY. 



21 



Edward B. Dana, Metuchen J. L. Suydam, Jamesburg 

F. M. Donahue, New Brunswick H. C. Symmes, Cranbury 

Wm. V. McKenzie, Metuchen A. Treganowan, South Amboy 

F. E. Riva, Mtlltawn C. H. Voorhees, New Brunswick 

C. M. Slack, New Brunswick N. Williamsonp New Brunswick 



No. members, 19., 



J. G. Wilson, 



Perth Amboy 



MONMOUTH COUNTY. 

Society organized July z6, i8z6. Annual meeting third Monday in May. 

C. Knecht, Pres,, Matawan W. U. Kurtz, Eatontown 

D. M. Forman, Sec^y, Freehold S. R. Knight, Spring Lake 



R. E. Andrews, Atlantic HighVds 
A. F. Applegate, Engiishtown 
Wm. B. Beach, Long Branch 
E. M. Beach. West 



I. S. Long, Freehold 

Sarah F. Macintosh, Asbury Park 



A. G. Brown, 
H. G. Cooke, 
Ellis W. Crater, 
Nathan Ervin, 
V. M. Disbrow, 
Edwin Field, 



Bed Bank 

New Brunswick 

Ocean Port 

Matawan 



Perrineville 

Asbury Park 

Imlaystown 

Allentown 

Keyport 

Long Branch 

Middletown 

Ocean Grove 



Wm. MacMillan, 
Henry Mitchell, 
F. C. Price, 
P. B, Pumyea, 
Edgar Roberts, 
Harry E. Shaw, 
Lakewood Edw. F. Taylor, 
Red Bank John Taylor, 
D. D. Hendrickson, Middletown Chas. H. Thompson, Belmar 

Wm. M. Hepburn. Freehold W. W. Trout, Spring Lake 

Manasquan Wm. B. Warner, 
Keyport Geo. F. Wilbur, 
Matawan Alex. Williamson, 
Allentown W. S. Whitmore, 
Asbury Park Scudder Wooley, 
Farmingdale J.H.Van yi^X^x, Atlantic HighVds 

HONORARY MEMBERS. 

Manasquan Geo. T. Welsh, Passaic 

Wm. A. Newell Allentown 

MORRIS COUNTY. 

Society organized June t, 1815. Annual meeting second Tuesday in May. 



A. H. Higgins. 
G. G. Hoagland, 
A. J. Jackson, 
Harris P. Johnson, 
Samuel Johnson, 
W. R. Kinmouth, 

Robert Laird, 
No. members, 40 



Red Bank 

Asbury Park 
<< 

Oceanic 
Long Branch 



H. W. Kice, Pres,, Port Oram 
N. H. Adsit, V,'Pres., Succasunna 
Levi Farrow, Sec'y, Middle Valley 
Jas. Douglas, Treas., Morristown 
E. P. Cooper, Rep., Troy Hills 



C. Anderson, 
G. A. Becker, 
A. E. Carpenter, 
A. R. Corwin, 
T. R. Crittenden, 



Madison 

Morristown 

Boonton 

Morris Plains 

Dover 



22 



MEDICAL SOCIETV OF NEW JERSEY. 



A. W. Condict. 
I. W. Condict, 
R. L. Cook, 
G. O. Cummins, 
Harris Day, 
H. V. Day. 
G. S. DeGroot, 

B. D. Evans, 
J. WilUrd Farrow, 

F, W. Flagge, 

G. H. Foster, 
W. S. Foster, 
Elliot Gorton, 
J. B. Griswold, 
H. A. Henriques, 
J. C. Houston, 
B. M. Howley, 
A. A. Lewis, 
H. B. McCarroll, 
A. A. Macwithey, 
P. S. Mallon, 

P. A. Harris, 
P. C. Barker. 

No. members, 52. 



Dover 



<» 



Chester 

Bloomingdale 

Mendham 

Morris Plains 

Dover 

Rockaway 

Flanders 

Morris Plains 

Morrisiown 
it 

Mendham 
Morrisiown 



Vompton 
Morris Plains 



W. H. Martin. 
C. N. Miller, 
L. L. Mial, 

F. W. Owen, 
H. M. O'Reilly, 
S. Pierson, 

T. P. Prout, 
S. H. Reed, 
Wm. H. Risk. 
J. B. Risk, 
J. G. Ryerson, 
J. S. Stiger, 

G. M. Swaim, 
E. Sutton, 

J. L. Taylor, 
H. C. Upchurch, 
Harr)' Vaughn, 
J. Walters, 
H. S. Wheeler, 
C. Wigg, 
W. J. Wolfe, 



HONORARY MEMBERS. 

Pater son C. Y. Swan, 
Morrisiown 



Madison 

German Valley 

Morrisiown 



t( 



<« 



Morris Plains 

Madison 

Summit 



«• 



Poonton 

Mendham 

Chatham 

German Valley 

Boonton 

Kenvil 

Morrisiown 

Port Oram 

Whippany 

Boonton 

Chatham 

Morrisiown 



PASSAIC COUNTY. 

Society organized July 14, 1844. Annual meeting third Tuesday in April. 



J. M. Stewart, Pres., Paterson 

J. L. Leal, V.-Pres., 

J. O'Donnell, Secy, 

George F'ischer, Treas., 

J. R. Merrill, Rep., 

J, H. Banta, Censor, 

P. A. Harris, " 

W. K. Newton, ** 

F. E. Agnew, 

A. J. Alexander, 

J. W. Atkinson. 



G. H. Balleray, 
J. S. Bibby, 
Chas. R. Blundell, 
W. Blundell, 
D. T. Bowden, 
J. A. Browne, 
V. E. Bullen, 
W. H. Carroll, 
D. R. Crounse, 
R. M. Curts, 
G. S. Davenport, 



Paterson 



i< 



«< 



Passaic 
<« 

Paterson 
Garfield 



MEDICAL SOCIETY OF NEW JERSEY. 



23 



S. De Jager, 


Paterson 


H. Parke. 


Paterson 


F. F. C. Demarest, 


Passaic 


J. P. Paxton, 


<« 


Edward F. Denner, 


Paterson 


H. V. Pike, 


ti 


T. J. Fitzmaurice, 


«4 


A. W. Rogers, 


tt 


William Flitcroft, 


«l 


B. H. Rogers, 


n 


0. V. Garnett. 


<( 


G. L. Rundle, 


Passaic 


J. T. Gillson, 


<< 


C. H. Scribncr, 


Paterson 


M. W. Gillson, 


«« 


W. R. Smith. 


Little Falls 


J. H. Henggcler, 


ft 


J. W. Smith. 


Paterson 


E. L. Henyan, 


<i 


R. Stinson, 


tt 


W. B. Johnson, 


H 


D. W. Sullivan, 


Passaic 


T. J. Kane. 


« 


Isaac Surnamer, 


Paterson 


H. Kip, 


t4 


M. J. Synott, 


Little Falls 


H. H. Lucas, 


<t 


C. Terriberry, 


Paterson 


M. A. Mackintosh, 


(( 


G. W. Terriberry, 


tt 


Btyan C. Magennis, 


<< 


R. A. Terhune, 


Passaic 


E. J. Marsh, 


l< 


P. H. Terhune, 


tt 


A. F, McBride, 


tt 


S. Van Dal sen, 


Fitter son 


J. C. McCoy, 


<l 


C. S. Van Riper, 


n 


S. R. Merrill, 


it 


C. Van Riper, 


Passaic 


Daniel T. Millspaugh, 


tt 


F. H. Todd, 


Paterson 


E. B. Morgan, 


(f 


G. Van Vranken, 


Passaic 


C. F. W. Myers, 


n 


George Vreeland, 


Paterson 


R. Neer, 


%% 


F. Vigna, 


tt 


W. Neer, 


ft 


W. J. Williams, 


tt 


T. F. O'Grady. 


• ( 







HONORARY MEMBER. 
J. C. Herrick, Colorado Springs, Col, 
No. members, 73. 

SALEM COUNTY. 

Society organized May 4, i%to. Annual meeting first Wednesday in May. 



Salem 



t* 



tt 



W. H. Carpenter. Censor, Salem 
G. W. H. Fitch, Rep., Daretown 



N. S. Hires, Pres,, 
R. M. Davis, V,'Pres„ 
Henry Chavanne, Sec*y and 

Treas., 
H. T. Johnson, Censor, 

Pedricktown W. H. James, 
Dain\GRrnson,Censor,Pennsgrove B. A. Waddington, 



F. Bilderback, 
W, L. Ewen, 
W. T. Good, 



Salem 

Alloway 

Quinton 

Pennsville 

Salem 



24 



MEDICAL SOCIETY OF NEW JERSEY. 



HONORARY MEMBERS. 

H. M. Christian, Philadeipkia.Pa, James Hunter, 
E. E. DeGroffz, Camden Capt. C. Mcllvaine. 

Geo. Freehes, Philadelphia^ Pa, 
£. B. Gleason, 
H. A. Hare, 

L. M. Halsey, Williamtown 

J. F. Hamilton, Philadelphia^ Pa, 
No. members, 12. 



Wesiville 
Phila,, Pa. 



<• 



>( 



(« 



(f 



Mordecai Price, 
B. T. Shimwel], 
Charles £. Turnbull, 
H. A. Wilson, 



«( 



II 



i< 



Woodbury 



SOMERSET COUNTY. 

Society organized May, 1816. Annual meeting last Thursday in April. 



W. H. Merrell, Pres., Mary E. Gaston. 

South Branch W. H. Long, Jr., 

S. O. B,Tay\or, V.-Pres.,Millslone B. B. Matthews, 

J. P. Hecht, Treas., Raritan J. F. McWilliams, 

A. L. Stillwell, Sec^y^ Somerville A. Nelson, 

J. H. Buchanan, Rep.^ L. T. Reed, 

North Plainfield W. B. Ribble, 



J. E. Anderson, 
J. B. Beekman, 
J. H. Cooper, 
H. V. Davis, 
C. R. P. Fisher, 
T. H. Flynn, 



Somerville 

Bound Brook 

Somerville 

Neshanic 

Somer%nlle 

East Millstone 

Gladstone 

Bernardsville 



Neshanic M. C. Smalley, 

Pluckemin F. C. Sutphen, 

Middlebush J. D. Ten Eyck, Franklin Park 

North Branch H. G. Wagoner, Somerville 



Bound Brook 
North Plainfield 



Bound Brook F. A. Wild, 
Somerville P. J. Zeglio, 

HONORARY MEMBER. 
John W. Ward, Trenton, 

ASSOCIATE MEMBER. • 

E. R. V^oorhees, M. D., C, Somerville. 
No. members, 24. 

SUSSEX COUNTY. 

Society organized August aa, 1829. Annual meeting third Tuesday in May. 



Bruno Hood, Pres,, Newton 

M. D. Hughes, V.-Pres., Lay ton 

S. B. Straley, Sec^y, Newton 

E. Morrison, Treas., *' 

T. H. Andress, Sparta 



Martin Cole, 
Jos. G. Coleman, 
E. Dalrymple, 
C. K. Davison, 
C. E. Dowling, 



L. G. Burd, 



Ogdensburg Chas. M. Dunning, 



Hainesville 

Hamburg 

Branchville 

Stanhope 

Sparta 

Franklin 



MEDICAL SOCIETY OF NEW JERSEY. 



25 



B. W. Ferguson, 
Jos. Hedges, 
P. N. Jacobus. 
J. N. Miller, 
John Moore, 
J. F. McCloughan, 



No. members, 23. 



Beemerville J. B. Pellet, 

Branckville J. C. Price, 

Newton John Strader, 

*' S. Voorhees, 



Hamburg 

Branchville 

Lafayette 

Newton 



Deckertown H. D. Van Gaasbeck, Deckertown 
Swartswood 

HONORARY MEMBER. 

Carlos Allen, Vernon, 



UNION COUNTY. 

Society organized June 7, 1869. Annual meeting second Wednesday in 

J. B. Harrison, Pres,, Westfield M. B. Long, 



F. A. Kinch, V,'Pres„ 

F. W. Sell. Secy, Rahway 

R. J. Montfort, Treas., Elizabeth 

R. B. Whitehead, Rep., 

F. C. Ard, Plainfield 

F. R Bailey, Elizabeth 

W. C Boone, 

T. F. Burnett, 



Victor Mravlag, 
C. W. McConnell, 
J. K. McConnell, 
T. N. McLean, 
VV. A. M. Mack, 
W. H. Murray. 
Plainfield E. R. O'Reilly, 
Elizabeth Albert Pettis, 



J. H. Carman, Plainfield Alonzo Pettit, 

W. F. Cladek, Rahway H. C. Pierson, 

J. AckermanColes, Scotch Plains J. B. Probasco, 



F. M. Corwin, 
M. E. Clowson, 
Thomas Dolan, 

A. Q. Donovan, 

G. W. Endicott, 
J. R. English, Jr., 
W. F. Gaston, 
William Gale, 
James S. Green, 
E. B. Grier, 

B. Van D. Hedges, 
E. W. Hedges, 
B. W. Hoagland, 
H. Page Hough, 
S. J. Keefe, 
T. F. Livengood, 

No. members, 56. 



Bergen Point S. T. Quinn, 

Plainfield John M. Randolph, 
Elizabeth J. P. Reilly, 

W. U. Selover. 
Plainfield R. A. Shirrefs, 
Irving ton A. Stern, 
Plainfield E. B. Silvers, 
Westfield R. R. Sinclair, 
Elizabeth G. W. Strickland, 

'* Charles H. Schlichter, 

Plainfield T. H. Tomlinson, 

W. F. Turner. 
Woodhridge A. F. Van Horn, 
Plainfield N. W. Voorhees, 
Elizabeth F. W. Westcott, 

N. L. Wilson. 



April. 

Plainfield 
Elizabeth 
Cranford 

Elizabeth . 

Plainfield 
Elizabeth 
Plainfield 
Elizabeth 
Roselle 
Plainfield 
Elizabeth 
Plainfield 
Elizabeth 
Rahway 
Elizabeth 

Rahway 

Westfield 

Roselle 

Elizabeth 

Plainfield 

Elizabeth 



«< 



Elizabeth 
Fanwood 
Elizabeth 



26 MEDICAL SOCIETY OF NEW JERSEY. 

WARREN COUNTY. 

Society organixe4 Febraary 15* i8a6. Annual meeting fint Tuesday in June. 

Louis C. Osmun, Pres,, F. W. Curtis, Stewartsville 

Hackettstown L. B. Hoagland, Oxford 

F. W. Haggerty, V.-Pres., Vienna John C. Johnson, Blairsttmn 
Wm. J. Burd, Se€*y, Belvidere F. J. La Riew, Asbury 
Wm. H. McGee, Treas,, " L.C. Osmun, Washington, D. C, 
J. H. Griffith, Rep,, Phillipsburg J. M. Reese, Phillipsburg 
W. C Albertson, Belvidere C. B. Smith, Washington 
Wm. C. Allen, Blairstown Wm. Stites, 

Isaac Barber, Phillipsburg G. O. Tunison, Oxford 

H. O. Carhart, Blairstown Alva C. Van SycVX^, Hackettstown 

G. W. Cummins, Belvidere Chas. M. Williams, Washington 

No. members, 21. 



SUMMARY. 



Atlantic, 


37 


Middlesex, 


- 19 


Bergen, - 


- - 36 


Monmouth, 


40 


Burlington, 


29 


Morris, - 


 52 


Camden, 


- 62 


Passaic, 


73 


•Cape May, - 


16 


Salem, - 


- 12 


Cumberland, - 


- 31 


Somerset, - 


• . 24 


Essex, 


- 183 


Sussex, - 


- 23 


Gloucester, 


- 27 


Union, 


- 56 


Hudson, 


80 


Warren, - 


- 21 


Hunterdon, - 


. 19 






Mercer, 


- 58 




898 



TRANSACTIONS 

OF THE 

Medical Society of New Jersey. 



One Hundred and Thirty-Fourth Annual Meeting. 



HELD IN ATLANTIC CITY, N. J., 

June 4, 5 and 7, 1900, 

LUTHER M. HALSEY, M.D., of Williamstown, President. 



FIRST DAY— MONDAY, JUNE 4TH. 

The meeting was called to order by the President, Dr. 
Luther M. Halsey, of Williamstown, at 12.35 P. M., and 
the session was opened with prayer by the Rev. Dr. 
Townsend. 

Hon. F. P. Story, the Mayor of Atlantic City, made an 
address of welcome, and spoke as follows; 

Mr. President and Members of this Society : 

The doctors of Atlantic City have assigned to me a very pleasant 
duty ; that of bidding welcome to the fraternity who visit our city. 
This is a pleasant duty, the more so as this is a society from our own 
state. I see among you many of the old faces that I saw here some 
years ago. The fraternity of doctors seems to have taken Atlantic 
City by storm. Almost everywhere you look you see a doctor, and I 
wonder what is to become of the sick at the homes of these doctors. 
At the same time I see that we are to be protected here, and there is 
no reason why anyone should be sick while in Atlantic City at this 
lime. 

I am here, to-day, to extend to you the welcome of Atlantic City. 
I hope this meeting will be a benefit to all of you as well as to our 
city. I assure you that the fraternity of doctors here have done all in 



All report i, papers, etc., marked thus (*) will be found in the Appendix. 



-30 MEDICAL SOCIETY OF NEW JERSEY. 

their power to give you a welcome ; and, on the part of the city and of 
its people, I now bid you welcome, and extend to you the freedom of 
the city. The box of the city having been broken, and the keys 
destroyed, I cannot hand them over to you, to-day ; but, perhaps,, 
to-morrow, at your mass meeting, I may have the keys of the city 
ready for you. While you are here you need have no fear, however^ 
I understand that there are to be many entertainments, and if any of 
you are to be out after midnight, you will find the telephone in work- 
ing order and the Mayor in town. (Applause.) It was my pleasure 
to get up early this morning, and address a meeting of the doctors at 
the Traymore, so I have not had my breakfast yet. I was to meet 
you here at twelve o'clock, and be back at my office at half-past 
twelve, but both hours have passed. However, we are here together,, 
and, I trust New Jersey will stay together so long as you stay together 
in this fraternity. 

Dr. Phillip Marvel presented the report of the Com- 
mittee of Arrangements. 

Dr. W. J. Chandler reported for the Committee on 
Credentials that forty-seven permanent delegates had 
been nominated. Only sixteen had presented certificates^ 
and two of these were irregular in form. The list of 
annual delegates published in the programme had been, 
duly certified. 

The regular reading of the minutes was dispensed with^ 
and, on motion of Dr. W. B. Johnson, the minutes as 
printed in the transactions, were approved, after making 
the following corrections : 

(i) Insert the name of Dr. Wm. A. Davis in the list of permanent 
delegates from Camden County. 

(2) Omit the name of Dr. H. M. Weeks from the list of permanent 
delegates from Mercer County. 

Page 50, nth line— 

After the word ** that " insert ** the District Societies be requested 
to raise," and after the words "per capita," insert "and that this 
amount be paid to the," etc. Also, in the 13th line, strike out the- 
word " other." The paragraph will then read as follows : 



MINUTES. 31 

•* It was then moved, that the District Societies be requested to 
raise three dollars per capita, and that this amount be paid to the 
treasurer of the Special Entertainment Committee, and that no 
assessment be placed upon the District Societies during the coming 
year. This was carried unanimously." 

On motion of Dr. Johnson, the election of permanent 
delegates was laid over until later in the session. 

Dr. W. B. Johnson, of Paterson, presented the report 
of the Business Committee.* 

Dr. George E. Reading moved, as an amendment to 
page 7 of the programme, that, instead of finally adjourn- 
ing on Tuesday morning, June 5, a final session be held 
on Thursday morning at 9. A. M. The reason for this 
was that a report could not be made before this time 
regarding the final work of the Entertainment Com- 
mittee. Seconded, and carried unanimously. 

On motion of Dr. Reading, the report of the Business 
Committee was received. 

Adjourned at 1.15 P. M. 

AFTERNOON SESSION. 

The meeting was called to order by the President at 

3.35 P- M. 

He then introduced Dr. W. W. Keen, of Philadelphia, 
the President of the American Medical Association, who 
spoke as follows : 

Mr. President^ Ladies and Gentlemen : 

It gives me a great deal of pleasure to be present this afternoon. 
I felt that, as the Medical Society of New Jersey, which, I believe, has 
the honor of being the very oldest medical body in this country, had 
been so courteous to the American Medical Association, the least its 
President could do. was to be present for a few moments this after- 
noon. In doing so, I find, quite unexpectedly, that I have won the 
blue ribbon (referring to the badge of the Society). Laughter and 
applause. 



32 MEDICAL SOCIETY OF NEW JERSEY. 

The President appointed on the Auditing Committee 
Drs. Young, Wilson and Baldwin. 

_ 9 

Dr. Elmer reported for the Committee on Ethics and 
Judicial Business that nothing had been brought before 
this committee, and that no meeting had been held. 

Dr. Archibald Mercer, of Newark, read the Treasurer's 
report.* 

On motion, it was received and referred to the Audit- 
ing Committee. 

The Treasurer then stated that, this year there was a 
large deficit, no money having been received from the 
county societies. Last year there had been a balance of 
$i,8oo; at present there was only a balance of $109.28. 
He then moved that the proper officer or officers be 
empowered to sell one of the thousand-dollar U. S. bonds 
(registered); and, also, that the assessment on the district 
societies be two dollars for each member. Seconded. 

Dr. English moved that this matter be referred to the 
Auditing Committee. Seconded by Dr. Chambers. Lost, 

Dr. Lamson then moved that this matter be referred 
to a special committee of five or seven, to report later. 
Seconded by Dr. Heifer, and carried unanimously. The 
Chairman appointed on this committee Drs. Lampson, 
English, Stout, Hollingshead and Rector. 

The report of the Corresponding Secretary was read by 
Dr. Chandler, the Corresponding Secretary being absent 
on account of illness.* 

On motion of Dr. Chandler, the report was received, and 
ordered placed on file. 

Dr. Chandler announced that Dr. H. Genet Taylor had 
sent word that no names had been presented for honorary 
membership, and that his committee had no further 
report to make. 

On motion, the report was received. 



MINUTES. 33 

Dr. E. J. Marsh, of Paterson, nominated for honorary 
membership, Lieut.-Col. Alfred L. Woodhull, of U. S. A. 
who, he said, had entered the service in 1861, had ren- 
dered important service in the War of the Rebellion ; 
besides having occupied numerous prominent positions 
since that time. Referred to the committee. 

Report of the Delegate to ** The Committee on Na- 
tional Legislation,*' of the A. M. A., appointed by the 
President : 

In response to an invitation of the Chairman of this committee. Dr. 
H. L. E. Johnson, of Washington, I was appointed to represent The 
Medical Society of New Jersey, on this committee. The committee 
met in Washington on May ist, and adjourned until the next day, to 
allow some of the members who had not yet arrived, to take part in 
the proceedings. On the second there were fifteen delegates present. 
The Chairman stated that the business to be considered had been 
arranged in the following order : 

1st. The Proposed Department of Public Health. 

2d. The Revival of the Publication of The Index Medicus. 

3d. Action upon the Senate Anti-vivisection Bill. 

4th. The Unification of Medical Practice Acts. 

5th. Other Medical Business Pending before Congress. 

The committee decided that nothing could be accomplished at 
present, toward securing a Department of Public Health, and decided 
to urge the adoption of Senate Bill No. 417 1, which gives the Marine 
Hospital Service additional powers in dealing with vessels from West 
Indian ports. The committee also approved the two bills having for 
their object the increase of medical service of the army, and a com- 
mittee of five was appointed to wait upon the Committees of the 
House and Senate having these matters in charge, and to urge their 
passage. In view of the fact that The Index Catalogue ** practically 
covered the field of The Index Medicus, it was deemed inadvisable to 
urge the reestablishment of The Index Medicus." 

Surgeon-General Sternberg stated that the Anti-vivisection Bill 
was practically dead for this session of Congress ; but that it would 
probably be revived next year, and would then need to be looked 
after. 



34 MEDICAL SOClfcTY OF NEW JERSEY. 

The committee decided to urge upon states that do not have a 
reciprocity clause in their law governing medical practice, the advisa- 
bility of adding a provision of that character, so that a physician 
registered in any state requiring an adequate examination may be able 
to practice in any state without further examination. 

The committee decided to recommend to The American Medical 
Association for action the following : 

The Committee on Legislation shall consist of three members, one 
of whom shall be a resident of Washington, one of Baltimore and one 
of Philadelphia. It shall be the duty of this committee to represent 
before Congress the wishes of this Association respecting pending 
legislation. This committee shall also invite to an annual conference 
to be held at Washington, one delegate each from the Army Medical 
Service, the Navy Medical Service, the Marine Hospital Service, the 
Bureau of Animal Industry, and from each State^ Society in affiliation 
with the American Medical Association ; such conference to consider 
questions of national medical and sanitary legislation, and report to 
their respective bodies for action. 

The committee also decided to recommend to the various State 
Societies that they provide in their laws for a committee of one on 
national legislation, who shall represent their respective societies at 
this conference. 

The committee approved the bill pending in Congress, to provide 
for the investigation of the pollution of the water supply of the City of 
Washington. 

On motion, it was ordered that the Chairman of this committee be 
one of the Committee of Five to go before the Congressional Com- 
mittees, and the committee was then appointed as follows : 

Drs. W. P. Goff. West Virginia; H. M. Bracken, Minnesota; L. B. 
Tuckernian, Ohio-; William H, Welch, Maryland ; H. L. E. Johnson, 
Washington, D. C. 

In conclusion, I would urge that The Medical Society of New 
Jersey continue its representation upon this committee, as it is capable 
of doing immense service to the profession by urging on salutary 
legislation; and, possibly, even more, by preventing pernicious legis- 
lation ; such, for instance, as the Anti-viviscctipn Bill, introduced in 
the present Congress. 

Respectfully submitted, 

GEOKGR EVANS READING, Delegate. 



MINUTES. 35 

Dr. Heifer then moved that the report be received, 
and its recommendation adopted. Carried. 

Dr. Reading then moved that the delegate to this 
Committee on National Legislation be included in the 
list of officers named by the Nominating Committee. 
Seconded by Dr. Johnson and carried. 

Under the head of Reception of Delegates, Dr. Fred- 
erick Holme Wiggin, delegate from the New York State 
Medical Association was introduced. He said: 

It gives me great pleasure to be the bearer of greetings from the 
New York State Medical Association to this ancient and honorable 
medical society. We believe m New York, that the great need of the 
profession at the present time is greater cooperation and better or- 
ganization. Our State Association has recently received a charter, 
which will enable us to reorganize our association on somewhat 
different lines from the present ones. We believe the unit of organ- 
ization should be the county associations, and that the state associa- 
tion should be a union of the county associations, and that the union 
of the state associations into the national association is the only logical 
and effective method. We shall shortly organize in this way. Our 
state body will probably be governed by delegates from the county 
associations in the ratio of one to ten, who will meet the day before 
the meeting of the state association. 

We also believe the time has come when medical societies must 
do more for their members than simply give them scientific essays. 
We propose to publish a medical directory for our members, and 
trust, in time, you will help us in that work. Eventually, we hope to 
protect our members more effectually against malpractice suits, which 
are becoming alarmingly common. It seems to be a fashionable way 
for many people to try to pay their physician's bill. Our annual 
meeting will occur in the third week of October, and, we hope to have 
a large delegation from the members of this society. 

On motion of Dr. Chandler, the regular order of busi- 
ness' was suspended, and miscellaneous business was taken 
up. 



36 MEDICAL SOCIETY OF NEW JERSEY. 

Dr. William J. Chandler presented the report of the 
Recording Secretary.* 

Dr. Alexander McAllister read the names of the mem- 
bers to serve on the various committees in connection 
with this meeting, as printed on the programme. 

On motion of Dr. W. B. Johnson, Dr. L. F. Bishop 
was invited to sit with the Society and take part in the 
discussions. 

Dr. Charles Young, for the Committee on Treasurer's 
Accounts, reported that the committee had examined 
the books of the Treasurer, and ^found them properly 
balanced. 

On motion, the report was accepted, and the committee 
discharged with thanks. 

Dr. H. W. Elmer, of Bridgeton, the Chairman of the 
Standing Committee, presented, in abstract, the report 
of that committee, and was given permission to enlarge 
it for publication. 

On motion, the report was received, and the committee 
was empowered to enlarge the report, as requested, be- 
fore publishing the same. 

Dr. Charles Young, of Newark, who was to have 
presented a report on the Progress in Surgery, explained 
that he had understood that these reports were merely to 
be presented by title at this meeting, and that, therefore,, 
he had not brought the report with him. 

On motion, permission was given to publish the report 
in the transactions. 

The same disposition was made of the report on 
the Progress in Medicine and Thereapeutics, by Dr. 
Dowling Benjamin ; the report on Progress in Diseases of 
the Nose and Throat, by Dr. T. W. Corwin, of Newark; 
and with the report on the Progress of Bacteriology, by^ 
Dr. J. C. Houston, of Mendham. 



MINUTES. 37 

Dr. E. L. B. Godfrey, of Camden, the Third Vice-Presi- 
dent, then read an essay entitled, "Typhoid Fever; its 
Relations to Water Supply, with observations concerning 
Treatment." * 

Dr. W. J. Chandler moved that each district society 
be instructed to send a copy of its by-laws to the Chair- 
man of the Standing Committee, that they may be 
reviewed by that committee, and such recommendations 
as they see fit may be offered next year. Seconded by 
Dr. Mercer, and carried. 

Adjourned at 5.00 P. M. 

EVENING SESSION. 

The meeting was called to order by the Second Vice- 
President, Dr. J. D. McGill, at 8.45 P. M. He occupied 
the chair during the delivery of the Annual Address. 
This was by Dr. Luther M. Halsey, of Williamstown, 
whose topic was, " Our Duty as Physicians to Consump- 
tives." 

On motion of Dr. English, a vote of thanks was ex- 
tended to the President for his able address. 

Dr. Dowling Benjamin, of Camden, then read the 
report on the Progress in Medicine and Therapeutics,* 

Dr. Elmer offered the following resolution : 

Whereas, The Medical Society of New Jersey has heard of the 
illness of Dr. William Pierson. for so many years its faithful and effi- 
cient Recording Secretary, and at present its First Vice-President ; 

Resolved, That this Society hereby expresses its profound regret 
that this illness should prevent his attendance at this meeting, and 
tenders to him its sincere sympathy, with earnest hopes of a speedy 
recovery and restoration to his accustomed sphere of usefulness. 

Dr. Elmer moved that this resolution be adopted, and 
that a copy of the same be transmitted to Dr. Pierson by 
telegraph. Seconded, and carried unanimously. 



38 MEDICAL SOCIETY OF NEW JERSEY. 

On motion of Dr. E. J. Marsh, Drs. Woodhull and 
Frick were invited to sit with the Society as correspond- 
ing members. 

On motion of Dr. Chandler, the regular order was sus- 
pended, and the Society returned to the election of 
permanent delegates. 

Dr. Chandler then moved that the Society proceed to 
the election of those nominees who had furnished proper 
credentials. Seconded and carried. 

The following is the list of such nominees: 

Atlantic — B. C. Pennington. Atlantic City ; W. B. Stewart, Atlantic 
City. 

Cumberland — M. K. Elmer, Bridgeton ; O. H. Adams, Vineland ; 
T. J. Smith, Bridgeton. 

Essex — Peter V. P. Hewlett, Newark ; Charles F. Underwood, 
Newark ; Theron Y. Sutphen, Newark ; L. Eugene Hollister. New- 
ark ; Charles D. Bennett, Newark ; Henry B. Whitehorn, Verona ; 
William B. Graves, East Orange ; Robert G. Manwood, Newark. 

Hudson — F. M. Corwin, Jersey City ; George E. McLaughlin, 
Jersey City : Joseph Rector, Jersey City ; Talbot R. Chambers, Jersey 
City ; Mortimer Lampson, Jersey City. 

Mercer — Thomas H. McKenzie. Trenton ; Charles F. Adams, 
Trenton. 

Passaic — Robert M. Curts, Paterson ; James M. Stewart, Pater- 
son ; Charles H. Screbner, Paterson ; John T. Gillison, Paterson ; 
Matthew A. Mackintosh, Paterson. 

5a/^>«— Henry Chavinne, Salem ; W. H. James, Pennsville. 

Somerset— k. L. Stillwell, Somerville. 

Union — W. L. Wilson, Elizabeth ; James S. Green, Elizabeth ; W. 
U. Selover. Rahway, 

On motion of Dr. Richard C. Newton, the Secretary 
was instructed to cast the ballot for the nominees by 
counties. This was done, and they were declared elected. 

The names of those who had been nominated by their 
district societies, but had not presented credentials in 
proper form, were read, as follows: 



MINUTES. 39 

Bergen — David St. John, Hackensack ; Samuel E. Armstrong, 
Rutherford. 

Mercer — J. C. Felty, Trenton ; Henry B. Costill, Trenton. 

Middlesex — F. M. Donuahue, New Brunswick. 

Monmouth — D. McLean Forman, Freehold ; Edwin Field, Redbank ; 
L. B. Pumyea, Allentown ; George F. Wilbur, Asbury Park ; Samuel 
Johnson. Asbury Park ; F. C. Price, Imlaystown. 

J/(tirr/> — James Douglas, Morristown ; Stephen Pierson, Morris- 
town ; F. W. Flagge, Rockaway ; Calvin Anderson, Madison. 

Warren — J. M. Reese, Philipsburg. 

On motion of Dr. Chandler, these names were laid 
upon the table, to be taken up for election as soon as 
they shall have presented proper credentials. 

Dr. Lampson presented the report of the Special Com- 
mittee on the Treasurer's Recommendation. It read as 
follows : 

** Your committee, to which was referred the recom- 
mendation of the Treasurer, would respectfully report as 
follows : We have considered the matter thoroughly, and 
concur fully with his conclusions. We submit the fol- 
lowing resolution, and recommend its adoption : '* 

Resolved, That the President and Treasurer be authorized to sell a 
one thousand-dollar bond to meet the debts incurred by the Society, 
and the expense of publication of the transactions for the year ; and 
also recommend that an assessment on the county societies of two 
dollars per capita be levied for the ensuing year. 

On motion of Dr. H. Elmer, the report was received. 

On motion of Dr. E. J. Marsh, the report and its 
recommendations were adopted. 

On motion of Dr. Mercer, the following bills were 
ordered paid : Orange Chronicle, $37.25 ; Standing Com- 
mittee, $16; Recording Secretary, $44.91; Treasurer, 
$13.71; Stenographer, $35, and the bill of the Corre- 
sponding Secretary (not on hand). 



40 MEDICAL SOCIETY OF NEW JERSEY. 

The Secretary then read the following names of dele- 
gates who had been selected by their respective societies 
to serve on the Nominating Committee. 

Atlantic — Emery Marvel; Bergen — D. A. Currie; Burlington — 
F. G. Stroud; Camden — Alex. McAllister; Cape May — Eugene Way; 
Cumberland— ]os. Sheppard; Essex — Charles Young; Gloucester — 
Geo. E. Reading; Hudson — Mortimer Lampson; Hunterdon— Geo. 
W. Bartow; Mercer — Thos. H. Mackenzie; MiddUsex^K, C. Hunt; 
Monmouth — W. R. Kinmouth; Morris — N. H. Adsit; Passaic — 
J. L. Leal; Salem — Henry Chavannc; Somerset — A. L. Stillwell; 
Sussex— \i, D. Van Gaasbeck; Unicn — H. Page Hough; Warren — 
Alva C. Van Syckle. 

Adjourned at 10.25 P. M. 

SECOND DAY— TUESDAY, JUNE 5TH. 

The meeting was called to order at 9.00 A. M. 

Dr. Henry Mitchell, of Asbury Park, read a report on 
the Progress in State Medicine and Hygiene.* 

Dr. VV. B. Johnson, of Paterson, the Chairman of the 
Committee on Medical Inspection of Schools, presented 
the report of this committee.* 

On motion of Dr. E. W. Hedges, of Plainfield, the 
committee was requested to communicate with the State 
Board of Education regarding the recommendations made 
by the committee.r 

Committee on Dr. Newton's Paper — Dr. R. C. Newton, 
of Montclair, said that the General Committee should 
take charge of all questions of better law, better schools, 
etc., and should go to the Legislature, and ask for appro- 
priate legislation. He hoped, therefore, that the com- 
mittee of which he was chairman, would be dismissed, 
and the matter turned over to a General Committee. 
He added that, although Dr. Baldwin takes great interest 
in this subject, illness prevented his being present at this 
time. 



MINUTES. 41 

On motion of Dr, T. R. Chambers, of Jersey City, the 
following resolution was adopted : 

Resolved, That this Society desires to express to Dr. H. R. Baldwin 
its sympathy and condolence in the illness which prevents his attend- 
ance at this meeting, and also its confidence in the advisability of his 
proposed milk inspection law. 

Dr. T. Y. Sutphen, of Newark, presented the report of 
the Committee on Abuse of Medical Charities.* 

Dr. W. B. Johnson moved that the report of the com- 
mittee be received, the committee continued, and that 
they be requested to carry forward such recommenda- 
tions for the preparation of such a bill. 

Dr. Henry Mitchell said that it was both proper and 
desirable that the Society should influence legislation. 
It had been responsible in the past for the organization 
of the New Jersey Sanitary Association and for the 
Board of Health. He thought Dr. Newton's suggestion 
a good one, that a committee examine the laws relating 
to dairy production of milk and milk supply, and make 
such additions as might be deemed necessary. These 
should be presented to the Legislature by the committee. 

Dn Newton remarked that this proposition would be 
for the good of the people of the state, and would add to 
the prestige of this Society. 

Dr. W. B. Johnson said that Dr. Sutphen's committee 
should be appointed in a regular way, and after such 
committee had made its report, the matter might be 
taken in hand by the Committee on Legistation. 

On motion of Dr. W. B. Johnson, this was considered 
as an amendment to last year's report. 

Dr. Hunt moved that a committee of five be appointed 
to be known as the Committee on Legislation, and that 
matters requiring legislative enactment be referred to 
that committee. 



42 MEDICAL SOCIETY OF NEW JERSEY. 

Dr. Newton moved, as an amendment, that the Presi- 
dent himself be a member of that committee, and that he 
be instructed as to the recommendations contained in the 
paper of last night. The motion, as amended, was 
carried. 

Dr. C. R. P. Fisher, of Bound Brook, reported for the 
Fellow's Prize Committee, that two essays had been pre- 
sented on the given subject, " Hydrophobia," and the 
committee had awarded the prize to Dr. Frederick Ran- 
dolph Bailey, of Elizabeth, for his illustrated paper 
entitled, " Hydrophobia, with some Experimental Re- 
searches in its Pathology." The committee also recom- 
mended that the essay be published with the illustrations 
as presented. Honorable mention was made of the other 
essay, which was prepared by Dr. Alonzo I. Hunt, of 
Hamilton Square. 

Dr. George E. Reading reported, on behalf of the 
Committee on Entertainment, that the various district 
societies had responded very generously to the demands 
made upon them, only one or two having failed, up to 
this time, to make up their quota. Some had sent con- 
siderably more than the three dollars requested of them. 
Apparently there would be no deficit. Dr. Reading 
added, that some of the money had been sent by mistake 
to the Treasurer of the State Society. 

On motion, the Treasurer, Dr. Mercer, was authorized 
to endorse this money over to the committee. 

Dr. R. C. Newton then moved that it was the sense of 
this Society that the recommendations of the President 
on the State Sanitation of Consumptives be carried out, 
if possible, and that it be referred to the Committee on 
Legislation, with instructions to report next year to this 
Society. Carried. 



MINUTES. 43 

The President then announced the appointment of Dr. 
F. G. Stroud on the Committee on the Medical Inspec- 
tion of Schools. 

Action was then taken on the amendments to the by- 
laws proposed at the last annual meeting. 

The first amendment proposed to change the time of 
the annual meeting from June to September. In order to 
test the feeling of the Society on this matter, Dr. T. R. 
Chambers moved the adoption of this amendment. It 
was overwhelmingly lost. 

The second amendment **to rescind Sec. 15, Chap. 11.,*' 
was then taken up. 

Dr. D. C. English moved to rescind Sec. 15, Chap. II., 
and to substitute the following : 

A committee of three shall be annually constituted by the 
Fellows, and their names announced to the Society to be 
called the ** Fellows Prize Committee," who shall, under 
such conditions as the Fellows may, from time to time^ 
approve, have charge of the awarding of such prize or 
prizes as the said Fellows may offer for essays. The con- 
ditions of the ofifer of prizes shall be published in the 
Transactions signed by the committee. 

The committee shall notify the successful author to be 
present at the next annual meeting of the Society. The 
committee shall report to the Society at the annual 
meeting, and announce the author of the approved essay, 
and, before the whole Society, the President of the 
Society shall make the award. The successful essay shall 
be the property of the Society, and be published in the 
Transactions. Seconded and carried. 

Dr. D. C. English then gave notice that, at the next 
annual meeting, an amendment would be offered to 
Chapter II., Sec. 12, striking out the words, "and one 
member of the Prize Committee." 



44 MEDICAL SOCIETY OF NEW JERSEY. 

The President then announced that the Fellows report 
that the following members constitute the Fellows* Prize 
Committee for the ensuing year: Drs. Luther M. Halsey, 
Henry R. Baldwin and David C. English. 

Dr. Charles Young presented the report of the Nomina- 
ting Committee, as follows : 

President— "Dr, William Pierson, of Orange. 

First Vice-President — Dr. John D. McGill, of Jersey City. 

Second Vice-President — Dr. E. L. B. Godfrey, of Camden. 

Third 'Vice-President — Dr. Henry Mitchell, of Asbury Park. 

Corresponding Secretary— X^x. E. W. Hedges, of Plainfield. 

Recording Secretary— Vix, William J. Chandler, of South Orange. 

Treasurer — Dr. Archibald Mercer, of Newark. 

Place of Meeting— ^<tv^y\xs\, 1901. 

Standing Committee — Dr. G. H. Bally ray, of Paterson ; Dr. William 
H. McGee, of Belvidere, for three years ; Dr. B. A. Waddington, of 
Salem, to take the place of Dr. Henry Mitchell. 

Business Committee — Dr. Walter B. Johnson, of Paterson ; Dr. 
Alexander McAllister, of Camden ; Dr. E. Morrison, of Newton ; Dr. 
B. C. Pennington, of Atlantic City ; Dr. E, Hollingshead, of Pemberton. 

Committee on Honorary Membership— \{. Genet Taylor, Chairman, 
Camden; Alexander W. Rogers, Paterson; Charles J. Kip, Newark. 

Committee on Arrangements — Dr. S. Johnson, of Asbury Park ; 
Dr. G. E. Reading, of Woodbury ; Dr. G. F. Wilbur, of Asbury Park ; 
Dr. D. A. Currie, of Englewood ; Dr. E. Fields, of Red Bank. 

Delegates to the American Medical Association — Drs. O. H. 
Sproul, of Flemington ; Dr. T. R. Chambers, of Jersey City ; Dr. N. 
L. Wilson, of Elizabeth, Dr. B. A. Waddington, of Salem; Dr. W. 
A. Clark, of Trenton ; Dr.* E. B. Silvers, of Rahway ; Dr. S. A. Harris, 
of Passaic; Dr. A. W. Taylor, of Beverly; Dr. P.M. Corwin, of 
Bayonne; Dr. E. Marvel, of Atlantic City; Dr. J. S. Long, of Free- 
hold ; Dr. Joseph Stokes, of Morristown ; Dr. L. M. Halsey, of Will- 
iamstown ; Dr. A. C. Van Syckle, of Hackettstown ; Dr. Eugene Way, 
of Dennisville ; Dr. A. McAllister, of Camden ; Dr. A. C\ Hunt, of 
Metuchen. 

Delegates to the New York Medical Society — Dr. Charles Young, 
of Newark ; Dr. E. B. Silvers, of Rahway ; Dr. D. A. Currie, of En- 
glewood. 



MINUTES. 45 

Delegates to the Massachusetts Medical Society — Dr. S. A. Heifer, 
of Hoboken ; Dr. J. A. Exton, of Arlington. 

Delegates to Pennsylvania Medical Society — Dr. M. A. Mackin- 
^ tosh, of Paterson ; Dr. C. F. Adams, of Trenton. 

Delegates to Maryland Medical Society — Dr. John C. McCoy, of 
Paterson; Dr. A. Dallas, of Bayonne. 

Delegates to New Hampshire Medical Society — Dr. C. R. Blan- 
chard, of Jersey City. 

Delegates to Rhode Island Medical Society — Dr. M. Lampson, of 
Jersey City. 

Delegates to Mississippi Valley Medical Society ^Dr. J. M. Rector, 
of Jersey City. 

Delegates to the American Pharmaceutical Association — \^r. 
Willianm K. Newton, of Paterson ; Dr. H. L. Coit. of Newark. 

Owing to the fact that the Society was to take action on an amend- 
ment regarding the time of meeting, the committee did not fix the 
time of the meeting. 

On motion, the report was adopted, and the whole 
ticket, as above named, was elected without opposition. 

On motion of Dr. George E. Reading, the next meeting 
was set for the fourth Tuesday, Wednesday and Thurs- 
day of June next. 

On motion of Dr. Chandler, the report of the Committee 
on the Directory was deferred until Thursday morning. 

On motion of Dr. H. Genet Taylor, a vote of thanks was 
extended to the President, for the able and efficient 
manner in which he had presided over the deliberations 
of the Society. 

The President appointed Dr. H. L. Coit, of Newark, 
on the Committee on Bovine Tuberculosis ; Dr. F. G. 
Stroud, on the Committee on Medical Inspection of 
School^; and, on the Committee on Legislation, Dr. 
Halsey, of Williamstown ; Dr. Leal, of Paterson ; Dr. J. 
D. McGill, of Jersey City ; Dr. E. L. B. Godfrey, of 
Camden ; and Dr. H. H. Herold, of Newark. 

Adjourned, to meet for a short ^business session on the 
morning of June 7th. 



46 MEDICAL SOCIETY OF NEW JERSEY. 

THURSDAY MORNING. 

The Society was called to order at 9.30 by the Presi- 
dent. The first order of business was the report of the 
Committee on Entertainment. Dr. Reading, Secretary, 
stated that this would have to be, necessarily, a verbal 
report ; that the final report could not, as yet, be made, 
owing to the absence of some bills, which had not yet 
been received ; that the American Medical Association 
had been successfully entertained, and many congratula- 
tions had been offered him on the delightful evening* 
which had been afforded the members; that there would 
be ample funds on hand to meet all expenses, and that 
he hoped some member of the Society would make a 
motion that the balance, if any, which might remain un- 
expended, should be turned over to the Treasurer of this 
Society. 

Dr. English moved that the report be received as a 
partial report, and that the committee be authorized to 
complete it and hand it to the Secretary for publication.* 

Also, that the thanks of the Society be extended to the 
committee for the excellent success of the entertainment 
and for the manner in which they had performed their 
duties. Carried. 

It was also moved and seconded, that any balance of 
funds not expended by the Entertainment Committee, 
be paid over to the Treasurer of the Medical Society of 
New Jersey. Carried. 

All delegates were requested by Dr. Newton to make 
sure of registration in the book provided for that pur- 
pose. 

The Secretary called attention of the Society to the 
matter laid over from the last meeting, the Directory of 
New York, New Jersey and Connecticut, and introduced 



MINUTES. 47 

Dr. Wiggin, of New York, who was here as a delegate 
from New York Medical Association, and desired to pre- 
sent the matter to the Society. 

Dr. Wiggin stated that he desired to thank the officers 
of this Society for the assistance which they had already 
given him, and to state that, in order to cheapen the 
issue of these directories, it was necessary to include the 
three states above mentioned, as last year the publication 
had been very expensive ; but, by having the medical 
men of the states to subscribe for the copies, the cost 
would be materially diminished ; that it was very im- 
portant to have all the members of the profession in the 
three states registered in the directory, and to have them 
subscribe to the book. No objectionable advertisement 
would be allowed to appear in the book, and it would 
thus be an improvement on many of the medical direc- 
tories published now. It would be valuable to physicians 
for the purpose of recommending physicians who did not 
reside in New York, when patients were moving from one 
place tp another. He hoped the Society would appropri- 
ate some funds in order to lessen the cost of publication. 

Dr. Chandler presented the following resolutions at the 
request of Dr. James S. Greene, Chairman of the Com- 
mittee on Medical Directory : 

Resolved, That, I. The Medical 'Society of New Jersey heartily 
endorses and recommends the Directory. 

II. The secretaries of the various district societies be requested to 
obtain the names of as many of their members as wish a copy of the 
Directory, and to send this list to the Secretary of the Medical Society 
of New Jeisey. 

Seconded and carried. 

Dr. English moved that the five delegates to the Pan- 
American Medical Congress, which meets in Havana, be 



48 MEDICAL SOCIETY OF NEW JERSEY. 

elected by the Society, and that the President appoint 
the remainder of the delegation, to which, as a society, 
we are entitled. Carried. 

Drs. D. C. English, David Warman, J. Y. Sutphen, J. 
E. E. Riva and L. M. Halsey were nominated and 
elected. 

The following resolution was presented by Dr. 
Chandler : 

Resolved, That hereafter all excuses for absence be referred to the 
Standing Committee for adjustment, in the same manner as the 
appeals from district medical societies (See By-laws, Chap. II., Sec. 7). 

Seconded, and carried. 

Dr. Elmer moved that the names of those permanent 
delegates who had been selected by the district societies, 
but had presented no credentials, should lie over till the 
next annual meeting of the Society. Carried 

The following is a list of nominees who failed to pre- 
sent certificates : 

Samuel E. Armstrong, of Rutherford, Bergen County; H. B. Cas- 
till, of Trenton, Mercer County; D. McLean Forman, of Freehold. 
Monmouth County ; Ed. Field, of Red Bank, Monmouth County ; P. 
B. Pumyea. of Allentown, Monmouth County ; Geo. F. Wilbur, of 
Asbury Park. Monmouth County ; F. C. Price, of Imlaystown, Mon- 
mouth County ; Samuel Johnson, of Asbury Park, Monmouth County; 
James Douglas, of Morristown, Morris County; Stephen Pierson, 
of Morristown, Morris County ; .F. W. Flagge, of Rockaway, Morris 
County; Calvin Anderson, of Madison, Morris County; J. M. Reese, 
of Phillipsburg, Warren County. 

The Secretary announced he had telegraphed to Dr. 
William Pierson the resolution of condolence passed by 
the Society, and also the fact that he had been elected 
President for the ensuing year. Telegrams had been 
received from Dr. Pierson, in response, thanking the 
Society for its sympathy, and for the great honor con- 
ferred on him. 



MINUTES. 49 

The Secretary stated that F. M. Donahue, of New 
Brunswick, and J. C. Felty, of Trenton, had presented 
certificates in proper form, and he moved that they be 
elected as permanent delegates. 

On motion, the Secretary was instructed to cast the 
ballot for these candidates, and there being no objection, 
they were declared elected. 

On motion the Society adjourned at ii.oo A. ]yi. Sine 
die, 

WM. J. CHANDLER, 

Recording Secretary, 



^ »^AN 8 1902 ^ 



APPENDIX 



TO THE r 



MINUTES. 



APPENDIX TO THE MINUTES. 



Report of thk Committee on Business. 

Gentlemen of the Medical Society of New Jersey : 

The Committee on Business present the printed programme for 
the order of the exercises of this the one hundred and thirty-fourth 
meeting of the Society. The State of New Jersey and the Medical 
Society of the State should and do feel honored and gratified that 
the American Medical Association has this year selected this State for 
its place of meeting. It has been necessary to curtail the scientific 
work of the State Society and give place to the meetings of the 
American Medical Association, which occur on the 5th, 6th, 7th and 
8th of June, the Medical Society of New Jersey meeting with the 
American Medical Association at the conclusion of its own meeting, 
and entertaining the Association at a formal reception on the evening 
of June the sixth. The question proposed for the customary discus- 
sion at the next annual meeting is : 

What reliance can be placed upon the image produced by the X 
Ray from a Medico-Legal standpoint? 

The Business Committee hopes that the committee appointed at the 
1899 meeting of the Society for the purpose of suggesting some 
method or plan which will result in arousing a more general interest 
in and distribution of the scientific work of the Society will report at 
this meeting a perfect method of procedure which will result in 
enhancing the value of the scientific work of the Society. The Busi- 
ness Committee urge upon the members of the Society in all sections 
of the State the desirability for next year of a more general participa- 
tion in the annual meeting, and suggest that those intending to read 
papers, present cases, pathological specimens 'or new instruments, 
make early application to the chairman of the Business Committee for 
position on the programme. 

Respectfully submitted, 

Walter B. Johnson, Chairman, 
Talbot R. Chambers, 
e. hollingshead. 



4t 



<t 



54 medical society of new jersey. 

Treasurer's Report. 

Dr. Archibald Mercer, Treasurer, in account with the Medical 
Society of New Jersey : 

Dr. 

June, 1899. Burlington Co. Bal. of Assessment, $ 2 00 

" Monmouth *' ** " 2 00 

July, 1899. Interest on U. S. Bonds 25 50 

Morris Co. Balance of Assessment . . 2. 00 

Sussex •• •• •« . . 2 00 

Oct., 1899. Interest on U. S. Bonds. 25 50 

Jan., 1900. Interest on U. S. Bonds 25 50 

Feb., 1900. Gloucester Co. pub. in Transactions. 45 5 S 

Mch., " Cumberland Co. pub. in Transactions. 4 37 

April, " Interest on U. S. Bonds 25 50 

$159 92 

To Cash balance in bank June, 1899 I1817 57 

" U. S. Registered Bonds 2,550 00 

I4.527 49 



Cr. 

June, 1899. W. J. Chandler, Rec. Secretary .. . .$ 38 41 

H. W. Elmer, Chairm'n Stand'g Com. 21 95 

E. L. B. Godfrey, Cor. Secretary 21 31 

Archibald Mercer, Treasurer '5 54 

Orange Chronicle Co 24 75 

Howard Savings Bank, Note of $725, 

with interest 750 00 

July, 1899. Dr. O. C. Ludlow, stenographer 65 00 

Sept., " Orange Chronicle Co 9 00 

Oct., •* L. J. Har^ham, printing Transactions. 400 00 

Dec, '* Orange Chronicle Co i 75 

Jan., 1900. L.J. Hardham, printing Transactions. 516 50 

$1,868 21 

June, 1900. By Cash balance in Bank, June, 1900.. 109 28 

" U. S. Registered Bonds 2.55000 

.527 49 



t< 



«< 



appendix to the minutes. 55 

Report of the Corresponding Secretary. 

Plainfield, N. J., June 4, 1900. 

To the Medical Society of New Jersey : 

The Corresponding Secretary respectfully reports that during the 
past year the transactions of the Society have been forwarded to the 
Secretaries of the several State and Territorial Associations, to the 
honorary members of the Society and to the various libraries through- 
out the State and country which have heretofore received them. 

In return no transactions from any State Society have been received 
by your Secretary, but I presume copies have reached some other 
officer of the Society and have been forwarded to Trenton as usual. 

This has been an uneventful year in the way of correspondence, as 
none has been received nor sent. Dr. Taylor's resolutions passed at 
the last annual meeting, that the Corresponding Secretary be directed 
to request each year the County Societies, taking them in rotation as 
they stand in the published transactions, to designate one of their 
number to read a paper before the State Society at its next meeting, 
was not carried out this year, owing to the almost purely business 
character of this meeting. 

While your Secretary has very little to report, he believes that no 
duties have been neglected. 

Respectfully submitted, 

Ellis W. Hedges, Corresponding Secretary. 



Report of the Recording Secretary. 

To the Medical Society of New Jersey : 

The amended by-laws make it incumbent on the Recording Secre- 
tary, instead of the Corresponding Secretary as heretofore, to keep a 
record of the Permanent Delegates, and to report annually to this 
Society various facts pertaining thereto. 

We have at present on our lists the names of seventy-seven Per- 
manent Delegates. The name of Dr. William A. Davis, of Camden, 
who was elected last year, was inadvertently omitted, while the name 
of Dr. H. M. Weeks, of Trenton, who was dropped for non-attend- 
ance, was in the same nfianner retained in the list published in the 
transactions. With these two exceptions the list as published is 
correct. 



56 MEDICAL SOCIETY OF NEW JERSEY. 

According to the amended by-laws the year 1900 was designated as 
the time for the election of Permanent Delegates, and in compliance 
therewith most of the District Societies have selected one or more 
nominees. 

One of the amendments passed last year made it the duty of the 
Recording Secretary to ascertain th? number of delegates to which 
each District Society was entitled in order to equalize the representa- 
tion. In order that there may be a more perfect understanding of 
this matter I take the liberty to remind you that Permanent Delegates 
were first elected in 1892. At that time sixteen District Societies 
presented the names of twenty-five candidates, who were all elected. 
Since that date and at times prescribed in the By-Laws additional 
delegates have been elected. Some District Societies have selected 
their full number at the proper times and have kept their quota full. 
Other Societies have for various reasons failed to select nominees, and 
consequently their quota has not been filled. 

In order to equalize this representation the By-Laws were last year 
amended and the Recording Secretary was instructed to ascertain the 
number of Permanent Delegates to which each District Society was 
entitled and to notify the Secretaries of the District Societies thereof. 
In accordance therewith the following circular letter was sent to the 
Secretary of each District Society as follows : 

THE MEDICAL SOCIETY OF NEW JERSEY, 
OFFICE OF THE SECRETARY. 

South Orange. N. J., Nov. 14th, 1899. 

Dr. : 

Secretary of the District Medical Society of the County 

of , N. J. 

Dear Doctor :— 

For various reasons many District Societies have failed to select the 
full number of nominees for Permanent Delegates to which they have 
been entitled. In order to enable such Societies to select their full 
complement, the By-Laws were amended at the last session of the 
State Society, and in accordance therewith it becomes my duty to 
ascertain the number of Permanent Delegates to which each Society 
is thereby entitled. 

Since 1892 your District Society has been entitled to a total of 

Permanent Delegates. You have at present such delegates. 

You are therefore entitled to additional Permanent Delegates. 



APPENDIX TO THE MINUTES. 57 

I would also remind you that the amended By-Laws designate the 
annual meeting in 1900 as the regular lime for the election of Perma- 
nent Delegates. If your membership remains as at present, your 
District Society, at its annual meeting in 1900, is entitled to select 

regular and additional (total ) nominees for 

Permanent Delegates. 

As soon as possible thereafter you are requested to forward to 
this office the full names and addresses of the nominees then selected. 

Yours very truly, 

William J. Chandler, Secretary, 

As a result of the elections in the different District Societies we are 
able to present the following list of nominees for Permanent Dele- 
gates : 

Atlantic — B. C. Pennington, Atlantic City ; W. B. Stewart, Atlantic 
City. 

Bergen — David St. John, Hackensack ; Samuel E. Armstrong, 
Rutherford. 

Burlimrton — No nominees. 

Camden -No nominees. 

Cape May — No nominees. 

Cumberland— h\. K. Elmer, Bridgeton ; O. H.Adams, Vineland ; 
T. J. Smith, Bridgeton. 

Essex — Peter V. P. Hewlett, Newark ; Charles F. Underwood, 
Newark ; Theron Y. Sutphen, Newark ; L. Eugene Hollister, New- 
ark ; Charles D. Bennett, Newark ; Henry B. Whitehorn, Verona ; 
William B. Graves, East Orange ; Robert G. Stanwood, Newark. 

Gloucester — No nominees. 

Hudson — F. M. Corwin, Jersey City ; George E. McLaughlin, 
Jersey City : Joseph Rector, Jersey City ; Talbot R. Chambers, Jersey 
City; Mortimer Lampson, Jersey City. 

Hunterdon— ^o nominees. 

Mercer — J. C. Felty, Trenton; Thomas H. McKenzie, Trenton; 
Henry B. Costill, Trenton ; Charles F. Adams, Trenton. 

Middlesex — F. M. Donuahue, New Brunswick. 

« 

Monmouth — D. McLean Forman, Freehold; Edwin Field, Red Bank; 
P. B. Pumyea, Allentown ; George F. Wilbur, Asbury Park ; Samuel 
Johnson, Asbury Park ; F. C. Price, Imlaystown. 



S8 MEDICAL SOCIETY OF NEW JERSEY. 

i1/(^rr/j— James Douglas, Morristown ; Stephen Picrson. Morris- 
town ; F. W. Flagge, Rockaway ; Calvin Anderson, Madison. 

Passaic — Robert M. Curts, Paterson ; James M. Stewart, Pater- 
son ; Charles H. Scribner, Paterson ; John T. Gillison, Paterson ; 
Matthew A. Mackintosh, Paterson. 

5«/<?w— Henry Chavanne, Salem ; W. H. James, Pennsville. 

Somerset — A. L. Stillwell, Somerville. 

Sussex — No nominees. 

Union— V^ . L. Wilson, Elizabeth ; James S. Green, Elizabeth ; W. 
U. Selover. Rahway. 

Warren — J. M. Reese. Philipsburg. 



Rkport of the Standing Committee. 

The sources from which material is to be gathered for this report 
are somewhat limited, from the fact that but eight reporters have 
fulfilled the duties assigned to them, and furnished reports to the 
Standing Committee. From such sources as are at our command, we 
beg leave to submit the following report : 

Whether the reporters are awakening to the fact that the meetings 
of the district medical societies are full of interest, or whether the 
societies themselves are beginning to realize that mutual conference 
may result in increased professional benefit, cannot be stated ; but, 
the almost unanimous report is that, better and more general society 
work has been done in the year past. 

Camden's sessions are well attended, " with scarcely a member 
absent." The various departments of medicine and surgery are 
reported on and discussed at the quarterly meetings. Cumberland. 
Gloucester, Mercer, Union and Somerset report particularly interesting 
meetings, and an increase in membership, with excellent papers by 
members and visiting delegates. If, as district societies, we can cultivate 
a medical interest, it will certainly reflect its character in our State 
Society. Of the many interesting subjects discussed at these meet- 
ings, we might mention the papers of Day, on Rational Therapeutics ; 
Adams, on Serum Therapy, in Cumberland ; in Mercer, of Adams, 
on Tuberculosis ; in which is urged the necessity of legal enactments 
for the isolation of tubercular patients, in the incipient stages, for 
proper care and treatment. 



APPENDIX TO THE MINUTES- 59 

With the exception of fifteen cases of variola at Seabright, reported 
by Dr. Field, and nine cases at Long Branch, no pestilential 
disease is reported as epidemic. The cases at Seabright were clearly 
traceable to an import from Norfolk, Va., and in the " scare " at 
Long Branch, the " takes," after vaccination from the tubes, were 
more numerous than from the points. 

Grip has again been prevalent to a greater extent than for a year or 
two past. Appearing later, in March and April, it seemed to have 
been attended with a larger mortality in the two extremes of life, due 
to complications and sequelae. An extensive epidemic of rubeola has 
prevailed in Cumberland, notwithstanding all quarantine efforts. The 
same condition of affairs has happened in Mercer, Somerset and 
Union Counties, and it would seem, from an experience in Cumber- 
land, that the attempted quarantine procedures in this usually mild 
and harmless of the eruptive fevers, are not only useless, but act as 
an annoyance to the inmates of the placarded houses, and have a 
tendency to make parents avoid calling medical aid for their children. 
Diphtheria has been sparingly reported ; some few cases in Camden 
County, and more extensively in Passaic County. Where existing, 
the specific value of the anti-toxin treatment is affirmed. 

Typhoid fever is not frequently mentioned — fewer cases than usual. 
In Mercer County, Dr. Sheppard reports a case of suppuration of the 
bladder, as a sequella, and another case, in which sponging and 
quinine and acentalid administered internally, seemed only to increase 
the high temperature, but the administration of ••thermol," was fol- 
lowed by a marked reduction. 

Of interesting cases. Dr. McAllister reports the birth of a child 
with ecstrophy of the bladder, two penes and two scrota; Dr. Taylor, 
the case of four aneurisms in one patient, of undoubted syphilitic 
origin ; Dr. Field, of Monmouth County, the negative results following 
the use of anti-tetanic serum injected within fifteen hours after the 
commencement of the attack. 

Dr. Clark, of Mercer County, highly endorses the possibility of 
aborting attacks of pneumonia by the free administration of soda 
salicylate in eight to ten grain doses every two hours, as recommended 
by Sebring, or until " the patient is fairly drunk with it." In Cum- 
berland County, Dr. Fogg reports an interesting case of cerebral 
hemorrhage in a lad of sixteen, with post-mortem examination. 

We but cite these few, and refer you to the county reports for 
details of these and other interesting cases. 



6o MEDICAL SOCIETY OF NEW JERSEY. 

Hospitals. Reports have been received of the good work being 
done in the St. Joseph's and Mercer hospitals, and the Eye and Ear 
Infirmary in Trenton. The Newark City Hospital is nearing comple- 
tion, and a new wing is being added to St. Barnabas, while an entirely 
new hospital is being erected in St. James' parish, Newark. Excellent 
work is done in the new hospital at Bridgeton, and we would particu- 
larly call the attention of the profession to the fact — a fact bearing 
on the question for discussion at this meeting, that the hospital staff 
will not conduct a dispensary in connection with the hospital. In 
Passaic, the Paterson General and St. Joseph's are in good working 
condition ; in the former, the Graham Memorial operating room, per- 
fect in all its details, has been completed, through a legacy left for 
that purpose, while the out-door department has been discontinued in 
the latter. Drs. James M. Stewart and John Merrill have been 
appointed to staff-duty to take the places, respectively, of Drs. A. W. 
Rogers and Cornelius Van Ripper, resigned. An isolation hospital 
for contagious diseases has been established at Paterson. The pro- 
fession of Union County have opposed the attempt to follow the 
present fad of county officials, to establish a local hospital for the 
insane. Efforts are being made in Atlantic City toward the suppres- 
sion of the practice of osteopathy in that locality. 

With the exception of Passaic County, and for that see report, but 
little is reported on sanitation. An epidemic of some fifty cases of 
typhoid fever in Trenton, during January and February, while the 
memory of the Philadelphia epidemic was still fresh, gave rise to con- 
siderable alarm, and the new reservoir was supposed to be the source, 
but investigation proved conclusively that the cause of the disease was 
the Delaware River. The filtration plant mentioned last year, is still 
under consideration. In Paterson, the water supply has been much 
improved by removing the*** in-take" five miles further up the river 
from that which has been the source of supply till a year ago. 

The ranks of our profession have been depleted by the following 
deaths: 

Burlington — Josiah Reeve, in Medford, December 25, 1899. 

Camden — Dilwyn Parrish Pancoast, in Camden, November 4, 1899; 
Benjamin S. Lewis, in Camden, March 9, 1900. 

Cumberland — Hamillton Mailly, in Bridgeton, Angust 30, 1899. 

Essex— Charles H. Winans, in Belleville, November 22, 1899; 
Samuel H. Pennington, in Newark, March 14, 1900. 



APPENDIX TO THE MINUTES. 6 1 

Hudson — F. E. Noble, in Jersey City, June 29, 1899; John J. Cun- 
neely, in Hoboken, September 30, 1899. 

Mercer — Lloyd Wilbur, in Hightstown, January 27, 1900. 

Middlesex — Charles H. Voorhees, in New Brunswick, May 13, 1900. 

Passaic — A. D. Jousset, in Paterson, December 8,1899; Dillon 
Drake, in Paterson, May 2, 1900. 

Somerset — Irving Fisher, in Harlingen, December 31, 1899. 

Sussex — Joseph P. Crouse, in Hamburg, April 12, 1900. 

Warren — John S. Cook, in Hacketstown, January i, 1900. 

Union — T. J. Jackson, in Springfield, October 29, 1899. 

Appropriate obituary notices of all of these have been forwarded to 
the Committee, and will appear in the Transactions. 

Responses to the subject suggested for the discussion at this meet- 
ing: '* To what extent does the charitable clinic curtail the revenue of 
the medical practitioner," have been fairly numerous. In considera- 
tion of the fact that the large majority of the replies insist that they 
do very materially affect our incomes, it may not be amiss to mention 
some of the replies which take a middle or opposite view. An 
unsigned communication from Camden County says : " More or less, 
in every way, but why need the right-minded physician care ? He is 
not in the world to cure the sick for money. The soldier wishes to 
do his duty well, he is glad of his pay, but his main notion in life is to 
win laurels. The preacher likes his salary, but his salary is not his 
main object in life, but to win souls. So the physician, he likes his 
fees, but his main object in life is to cure the sick, and he would rather 
cure his patients and lose his fee, than kill him and get it." We are not 
so sure, but that Dr. McAllister properly rebukes the profession, when 
he writes, " By the unbounded liberalities of the medical profession, 
multitudes of clinical paupers are made, and there is nothing strange 
about it. Few men would buy clothes if merchants gave them 
gratuitously ; few would buy bread if bakers opened free dispensaries, 
for the same reason, many will not buy medical advice when it can 
be had gratis." Dr. Marcy, of Riverton, thinks it makes but little 
difference. Those who are too poor to pay, will go to dispensaries, 
and those who can pay and go to dispensaries, will not remunerate 
the physician in any case, so that, under all considerations, the 
charitable clinic is rather a blessing. 

Respectfully submitted, 

H. W. ELMER, Chairman. 



62 medical society of new jersey. 

Report on Progress in Rhinology and 

Laryngology. 

BY T. W. CORWIN, M.D., NEWARK, N. J. 

The last year of the century finds the domain of laryngology occu- 
pied by many zealous workers, and the literature is replete with new 
observations and careful classifications of older ones. 

The organization of medical men for scientific advancement is con- 
stantly becoming more effective. The proceedings of medical societies 
are more and more practical and important. A notable feature of 
many meetings has been the reading of several essays upon a single 
topic, as viewed from different personal or practical standpoints. The 
discussions which follow scintillate with wit and wisdom. 

The volume of laryngological literature has become so great that a 
year book devoted to it and olology has been published. I wish to 
acknowledge much indebtedness to it as an index to many papers and 
for a review of others not accessible to me. 

Cieneral systematic infection of nasal origin has recently been 
brought to the attention of the profession in England (see Progressive 
Medicine, 1900). 

Dr. Carter, of Liverpool, in 1895, published a series of cases of a 
hectic type of fever, the origin of which was for a long time obscure. 
It was finally explained by the condition of the nose. 

The case of a medical man is mentioned. He lived in a healthy 
seaside town, under most favorable conditions, but suffered daily from 
rigors, which occurred with all the regularity of ague. Although 
suffering much discomfort, and often with a temperature of 103° F., he 
continued his professional work. The lungs, heart and other organs 
were found normal. The only sign of any lesion was the expectora- 
tion of a little mucus every morning. An examination showed a 
catarrhal condition of the left nostril, Irrigation with liq. sod. chlor., 
followed by insufflation of boric acid powder gave immediate and 
permanent relief. 

In another case simulating typhoid fever, rhinoscopic examination 
revealed the presence of dead bone in the postr nares. Relief followed 
Its removal. 

In both of these medical gentlemen, the existence of a nasal lesion 
had not been suspected. 



APPENDIX TO THE MINUTES. 63 

MEMBRANOUS RHINITIS. 

In the report of last year, reference was made to the subject of 
membranous rhinitis. This has been written upon by several 
observers. It appears to be more and more commonly recognized as 
essentially diphtheritic in character, albeit the germs seem frequently 
to have lost somewhat of their virulence. There continues to be 
much diversity of opinion about it. Unless cultures have been taken 
and found negative, the cases should certainly be quarantined. In the 
speaker's experience all cultures so*far have shown the Klebs Loeffler 
bacillus. 

ATROPHIC RHINITIS 

has received much attention recently, although little new light has 
been shed upon it. 

Under culture the bacillus mucosus of Abel, and the pseudo diph- 
theritic bacillus have been frequently found along with others by 
Cozzolino, the former one being considered characteristic, yet bearing 
no relation to its etiology. He claims that the various bacilli are 
found, because the field is favorable to their development. He con- 
siders, however, that the bacillus mucosus accounts for the foetor and 
crusting. He maintains that the disease starts in the bone — that the 
tendency to it is congenital — in other words, that the ozenous patient is 
born ozenous. 

Lennox Brown refers to its association with a facial condition con- 
sisting of abnormal patency of the an'tr nares, with upturning of the 
nose. This allows the air to pass directly through the nose without 
going to the upper part. The inferior turbinal is thus exhausted, and 
the air being insufficiently warmed and moistened, dries the naso 
pharynx and lower respiratory passages. 

An interesting symposium upon this subject was held, in March, of 
this year, before the laryngological section of the New York Academy 
of Medicine. 

Doctors Bosworth, Myles and Rice considered the disease to begin 
in early life, as a purulent rhinitis, affecting first the surface epithelium,, 
and assuming additional characteristics as the disease extends to and 
destroys the mucous glands and other structures. 

Rice adds, that it is often due to neglect of the nose in infancy. 

The importance of distinguishing between atrophic rhinitis and 
functional collapse of the nasal tissues is dwelt upon by Dr. Rice. 

We find in many cases of general exhaustive malnutrition and 



64 MEDICAL SOCIETY OF NEW JERSEY. 

anemia, a dry condition of the nose, in which the membrane covering 
the turbinate processes is shrunken so as to lie close to the bone, 
while the bone itself shows little or no change in contour. The color 
of the membrane corresponds to that of the skin and tissues in .gen- 
eral, being usually remarkably pal id. The nasal passages are, of 
course, much broader than normal ; a small amount of dried secretion 
is seen, especially in the naso pharynx and pharnyx. There is some 
odor, but never the intense foetor of ozoena. The trouble is not 
commonly seen before young adult life. 

On the other hand, atrophic rhinitis or ozaena commonly 
occurs in young subjects ; is associated with sunken nose 
and wide nostrils. The patient may be well nourished ; the mucous 
membrane may have a bright color ; the surface is granular, and often 
the bones partly destroyed ; the muco-pus is abundant, forming 
extensive crusts, and it is horribly foetid. 

Hygiene, tonics, change of air and cleanliness will usually cure the 
collapsed condition of the nose along with the progress of the general 
health. 

As regards the use of formalin, Bronner, of Bradford, England, 
injects a solution of one part in i,ooo or 2,000 of water from a small 
nasal syringe, or if used as a spray, he advises a solution of twice this 
strength, containing also a little glycerine. Further dilution is indicated 
if any pain is produced. 

Treatment : French — General hygienic regulations. Constitutional 
treatment where indicated — tonics, etc. ; climatic treatment. 

(Iron, arsenic, iodine, oil, inunctions ; out-of-door life, daily cold 
baths with sharp frictions, linen mesh or wool underclothing, etc.) 
Local cleansing treatment. 

Uelavan believes that removal -of obstructive conditions in early life, 
as adenoid growths or septal deformity, may prevent the development 
of the disease. 

He claims that it is now less frequent than formerly among certain 
classes, and that this. is due to the greater promptitude with which 
obstructive conditions are now removed. 

The use of cotton plugs, occasional curreting and galvano-cautery, 
vibratory massage, galvanism and electrolysis was also adverted to. 

Dr. Knight — The local treatment is summed up in this injunction, 
to keep clean. He recommends normal salt solution, applied by 
spray, douche, syringe, snuffing, swabbing and post-nasal syringe. 



APPENDIX TO THE MINUTES. 65 

He recommends, after cleaning, the use of : menthol in albolene, 
five percent., up to tolerance; formaldehyde, boroformalin and boro- 
lyptol, ichthyol, and gomenol, a distillate from the leaves of melalenca 
viridiflora. a tree of New Caledonia. It is a strong antiseptic. 

We may congratulate ourselves that, while some of these cases can- 
not be cured, the foetid character of the secretions can be controlled, 
so that the sufferers may mingle with their fellows without restraint. 

In addition to the above treatment may be mentioned that, by 
cupric electrolysis, advocated by McBride, and the insufflation of 
equal parts of citric acid and sugar of milk, as a remarkable deodo- 
rizing powder. 

The treatment by antitoxin does not seem to make much headway. 
Some observers claim that it does no good, and others admit that it 
has man\ drawbacks. Frankenherger. who reports three cases of its 
favorable action, obtained exactly analogous results in a fourth patient 
from injections of saline solution, of which fifteen were given. 

It has been inferred that the serum and the saline, as well as the 
electrolysis act by stimulating osmosis, rather than by any anti-para- 
sitic influence. 

Dr. E. Pynchon contributed an article to the September Laryng- 
ologist on excision of portions of the hypertrophied middle turbinal, 
when exerting pressure. The symptoms are headache and nervous 
•irritations with, often times, imperfect ventilation and drainage of the 
nasal attic. 

He cuts a slot in the bone above the prominent extremity, using 
the electro-trephine and scissors. The excision is completed by 
snaring off the remaining horizontal process. Your reporter has 
found incision curative in a number of such cases. He has found 
the cutting forceps curette of Dr. Myles very convenient. With this 
a vertical slot is made behind the anterior extremity, and the extision 
is completed by the snare carried above the mass. 

DEFLECTIONS OF THE SEPTUM 

receive much attention. An interesting symposium was held recently 
before the laryngological section of the New York Academy of 
Medicine. The different operations were presented by their authors, 
Drs. Bosworth, Asch, Watson, Greason, Douglass and Roe. 

The Asch operation appeared to obtain most favor, but the method 
of Dr. Gleason was also approved. Doubtless all these procedures 
will be found of service, each applying to its special class of cases. 



66 MEDICAL SOCIETY OF NEW JERSEY. 

SINUS CATARRH. 

The frequency of sinus trouble was alluded to in our report last 
year, and further observations confirm the deductions then made. 

Lennox Brown concludes that chronic sinusitis of all the cavities is 
frequently overlooked in its acute stage, but undergoes spontaneous 
cure or remains latent in a large proportion of cases. 

Lapalle found ip a series of 169 autopsies, the deaths being from 
various causes, disease of the sinuses existed in fifty-five, or 'hirty-two 
per cent., and similar statistics are given by other observers. 
. Several sinuses may show infection in a single case, so that maxil- 
lary empyema was found in forty-eight ; sphenoidal empyema in 
nineteen; ethmoid in six, and frontal in five. 

Dr. Turner says the question arises whether these pus deposits may 
have in some cases caused death, while secondary to other disease in 
other cases. 

If all such empyemic cases were affected during the latter part of 
life the percentage of cases going about with such disease must be a 
large one. 

A sufficient number of autopsies have shown that meningeal and cere- 
bral complications have followed suppuration in some of these cavities 
when no opportunity had been afforded of diagnosing the exact con- 
dition during life. The frequency of infection of the sphenoidal sinus 
is also remarkable. 

The relation of ethmoidal disease to asthma was discussed by the 
American Laryngological Association, in 1899. 

In many cases of asthma oedematous conditions prevail in the 
ethmoid region, proceeding to the development of polypi. Bosworth 
claimed that asthma was a vnso-paresis, and not a spasm ; that an 
ethmoiditis was the cause of it all ; that drainage of the cells by bur- 
ring through the bony walls was the treatment. 

Others believed that other causes lay behind the nasal condition, as 
neurotic factors, general condition of the body, and irritations from 
distant sources other than the nose. 

A similar discussion was held before the London^ Laryngological 
Society, and the opinion was quite general, that much relief, and even 
some cures might result from treatment of any nasal disease present . 
but, that it was impossible, in any given case, to promise cure, or even 
relief to the patient. The very rational view was taken, that in any 



APPENDIX TO THE MINUTES. 6/ 

asthmatic with diseased nasal cavities, the latter should receive treat- 
ment, and the possibility of benefit presented to the patient as an 
argum-ent in favor of nasal treatment. 



TUBERCULOSIS LARVNGIS. 

The use of lactic acid with curettement in suitable cases seems to 
continue the favorite active treatment. Lake uses intra-tracheal 
injections for cases with granular and superficial excoriation or ulcera- 
tion. In oedema an superficial ulceration and scarification or curetting, 
followed by lactic acid or formaldehyde. In extensive and deep 
ulceration, iodoform and othoform are used until the parts become 
tolerant, and then formaldehyde. He regards orthoforin as very 
efficacious in dysphagia. For intra-tracheal injections he uses lano- 
line contaming three per cent, of naphthaline. 

T. J. Gallagher contributed a paper at the last meeting of the 
American Medical Association, in which he dwells on the utility of 
formaldehyde. He sums up as follows : 

1. It is safe to allow the patient to use a mild solution of 1-5CO two 
or three times a day. 

2. The relief to the dysphagia is very marked, and in many cases 
formaldehyde is a good substitute for cocaine. 

3. Its most brilliant results are to be seen in the vegetative and 
ulcerative types. 

4. It is the most satisfactory remedy I have ever used in infiltrative 
cases. 

5. The results are probably due to its effect upon histologic tissues, 
as well as upon the bacilli themselves. 

6. The stronger solutions, from one to ten per cent, should be 
applied two or three times a week as deemed expedient. 

G. L. Richards uses para mono chlor. phenol, applied in four to ten 
per cent, solution in glycerine and water, and finds it to increase the 
effect of lactic acid. 

At the discussion. Dr. Coulter recommended guiacol applications, 
five to one hundred per cent, strength, and finds it followed by an- 
aesthesia. 

Dr. E. Mayer has found absolute alcohol satisfactory in the pro- 
liferative forms of the disease. 

Dr. Berens reported a cure to the New York Academy of Medicine 



68 MEDICAL SOCIETY OF NEW JERSEY. 

and exhibited the case. He used submucous injections of creosote 
curetting, followed by pure mono ortho chlor. phenol and. later, 
ichthyol. 

Dr. £. B. Greason speaks of the relief attending the use of ortho- 
form in dysphagia. 

Your reporter can also testify to the wonderful effect of orthoform. 
It can often give complete relief to all pain for many hours at a time. 
Under its use starving patients take food freely and regain strength, 
and if the vitality is sufficient the ulcerations will often heal. 

Your reporter would also take occasion to announce the utility of 
protargol in five to twenty-five per cent, aqueous solution. A viscid 
liquid is obtained. This has been injected into the trachea to the 
extent of one or two drachms every day or two. It affords immedi- 
ate relief and the infiltration subsides. Orthoform may be suspended 
in it when ulcerations attend. 

CERVICAL LYMPHOMA. 

Jessen (Centralblatt of in. Med.) reports a number of cases of large- 
ness of lymphatic glands which had resisted all ordinary methods of 
treatment, yet which disappeared promptly after the removal of aden- 
oids from the naso pharynx. 

Your reporter has noticed the very frequent association of enlarged 
postmaxillary cervical glands with these adenoids. They attend 
nearly all cases which apply for treatment, and may usually be held 
to indicate the presence of adenoids when an inspection of the mouth 
and throat shows no other occasion for them. 

TONSILS. 

The tonsils as portals of infection, was the subject of an excellent 
paper by Dr. Eniil Mayer, before the New York Medical Association. 
Dr. Packard has also written at length upon this important topic. 
Dr. Mayer sums up his paper as follows : 

1. Infection arises in the tonsil. 

2. Tonsillar affections are frequently serious in their sequela, and 
every step to prevent recurrent attacks should be taken. 

3. The existing tonsillar disease should be energetically treated. 

4. Careful examinations and treatment are absolutely essential in 
the interini. 

5. Following anginas, the heart and other organs should be 
examined from time to time. 



APPENDIX TO THE MINUTES. 69 

In threatened quinsy or peritonsillitis, Mayer says that if seen with- 
in twenty-four hours of its outset it can usually be aborted by use of 
this prescription: ^ Morph sul. gr. i: Tr. verat virid 31; Aq. ^iv. 
Sig : Teaspoonful every hour for three hours, then once in three hours. 

REMOVAL OF TONSILS. 

Dr. J. H. Coulter read before the American Medical Association a 
paper embodying the results of three hundred tonsillectomies, with 
his conclusions. He operates with electro-cautery. He prefers this 
operation in all cases because the whole tonsil is removed, whereas 
tonsillotomy leaves a tonsillar stump behind. He holds that it gives 
a cosmetically perfect throat ; prevents the possibility of a return of 
tonsillitis, and leaves no opportunity for absorption of toxins or 
bacilli at that point; it liberates and allows perfect action of the 
pillars and soft palate, this result holding whether the pillars were 
adherent from inflammatory action or bound together by a cicatrical 
stump, the result of a former tonsillotomy ; if properly done it will 
leave a smooth surface which is important to singers ; pillars which 
were previously hypertrophied will promptly retract to a more normal 
contour and size. 

He claims that it has been a safe operation and that there has 
been no serious hemorrhage, and that it is less liable than the ordin- 
ary operation to that complication. 

Your reporter has had very satisfactory results from several tonsil- 
lectomies. The method has been the simpler one of seizing the 
organs with a double tenaculum, dragging them well out of their 
pockets and excising them with a scissors, or where hemorrhage 
might be feared, with a strong cold wire snare. 

DIPHTHERIA. 

J. H. Adair {Northwestern Lancet, St. Paul) concludes on investi- 
gation that while the K. L. bacillus is present in every case of diph- 
theria, its presence is no guide to the virulence of the disease. He 
finds the K. L. bacillus, or one morphologically identical, in nearly 
one-third of all children, about as frequently in those who have never 
had diphtheria as in those who have had acute attacks, but in the 
former it is more liable to occur as a variant type. He does not 
believe it possible to permanently dislodge the bacillus from the nose 
and throat with the means at present available. 

In a French review it is claimed that recent research establishes 



JO MEDICAL SOCIETY OF NEW JERSEY. 

that ihe Loeffler bacillus does not penetrate much beyond its entering 
point, and that it does not find its way into the blood and organs 
except when it is associated with the staphylo or streptococcus. In 
this case it is found in the blood and organs in abundance. Barbier's 
theory that the diphtheria bacillus does not find a ready foothold in 
man and that it requires a soil prepared by some other infection is 
thus supported. When the streptococcus is associated with the diph- 
theria bacillus the general condition is serious. The patient has both 
diphtheria and septicaemia. 



Progress in Bacteriology. 

BY J. C. HOUSTON, M.D., MENDHAM, N. J. . 

Progress in bacteriology is necfssanly slow. Scientific research in 
this branch of medical science must be pursued in a conservaiive and 
conscientious manner — the bacteriologist comparing his results 
with those of the experienced clinician, in order that the medical pro- 
fession may rely upon such results as a valuable aid in the diagnosis, 
prognosis and treatment of disease. 

The past year does not seem to have brought forth any startling 
developments. To be of practical importance to the profession in 
general, progress must be along those lines which offer a fairly rapid 
method of distinguishing between the various disease-producing micro- 
organisms—as in tuberculosis, by Staining methods; in diphtheria, 
by culture and Staining methods combined, or as in typhoid infection, 
by action of certain tluids of the body upon the specific organism of 
the disease in question. Diphtheiia and tuberculosis remain in the 
same relation to the physician as heretofore, except possibly to have 
become more firmly established as a routine practice in the diagnosis 
of these diseases. Typhoid fever and the Widal test have not come 
up to our expectations as a means for early diagnosis, but as confirma- 
tory evidence it is of value. A negative result with this test may not 
mean absence of typhoid infection, while a positive one should not be 
lightly regarded, even when the symptoms may be of a mild character. 

Probably of more interest at present is serum therapy. The treat- 
ment of diseases known to be caused by a specific micro-organism is 
at the present time undergoing radical changes. These changes have 
been in progress about ten years and seem in some instances to offer 
greater advantages than we have heretofore known. During these 



APPENDIX TO THE MINUTES. 71 

years a number of therapeutic serum have been used with varying 
results. Now we seem to be approaching nearer the desired end, i.e., 
therapeutic sera which have either a curative or modifying effect upon 
the diseases for which they are used. After the discovery of the pest 
bacillus an effort was made to produce an antitoxin for this disease. 
First results from its use among those suffering from the plague 
were not very satisfactory. During the epidemic of bubonic plague 
in India, in 1897, the German commission did not give a very favor- 
able report on the use of this serum, so far as its being curative was 
concerned, but the fact was shown that the serum used had certain 
immunizing qualities. 

Dr. Roux and his collaborators of the Pasteur Institute finally pro- 
duced from the horse an antitoxic serum of considerable strength. 
This serum was used in Oporto, Portugal, with very gratifying results 
by Dr. A. Calmette, director of the Pasteur Institute, Lille, France. 
In his report of this epidemic he says : "After the introduction of 
the serum in the Pest Hospital the death rate was reduced from 
thirty-three per cent, to thirteen per cent, of cases treated." No 
deleterious effects were noted after the injections. Immunization 
seems to last about thirty (30) days. 

Diphtheria antitoxin continues to be used, where it can be obtained 
readily, for the treatment of this disease. The liquid preparation has 
been generally usf*d, but in a paper by Dr. Louis Fischer, of New 
York city, before the section in diseases of children of the American 
Medical Association, some interesting facts are given with regard to 
five cases treated with dry antitoxin of Behring. " The dry antitoxin 
contains no foreign antiseptic and is prepared by adding, immediately 
before use, from one to four c.cm. of cold sterilized water by means 
of a sterilired pipette into a bottle of antitoxin. The solid serum 
dissolves slowly. Bottles containing one thousand units constitute a 
heahng dose, and in a very malignant case it was necessary to repeat 
this dose." 

In concluding. Dr. Fischer says : " A very important point and 
one worth noting is that there was no distinct reaction immediately 
following the injection, nor was there any later in the disease. All 
five cases recovered without any sequels. A noticeable point was 
that not one of the children complained of pains in the joints follow- 
ing injection. In none of the cases injected was there an antitoxin 
rash following the injection of the dry antitoxin. Antitoxin is no 



72 MEDICAL SOCIETY OF NEW JERSEY. 

longer an experiment, and therefore, without wishing to over-estimate 
this new product. I feel warranted in advocating its use in every form 
of diphtheria, and more especially in very malignant forms. No 
more than two thousand units, the contents of two bottles each 
containing one thousand units, was necessary to effect a cure." As 
in the use of all hyperdermic medication, strict aseptic precautions 
are required in administering the antitoxin. 

The serum treatment of pneumonia due to infection by F^raenkel's 
germ, has not become popular at present. Some interesting facts, 
however, are recorded in a paper by Dr. Antonio Fanoni. read before 
the Italian Medical Society of New York city, and published in Pedi- 
atrics, May 15. 1900. Pane's serum overcomes the septicaemia pro- 
duced by Fraenkel's germ in rabbits in a manner that cannot be 
disputed, This fact has been confirmed by all observers who have 
experimented with this serum. Of eighteen cases treated with this 
serum by Dr. Fanoni, only one died. ** This serum, when injected 
in cases of pneumonia early enough in sufficient quantity (40 c.c. of 
No. 2 daily), and if not deteriorated by age, quickly produces a lower- 
ing of the temperature and an improvement in the subjective comfort 
of the patient as well as an amelioration of all the other symptoms. 
Resolution also tends to take place more rapidly." 

It would seem that this serum may be of value in infections pro- 
duced by Fraenkel germ, but more must be known regarding pulmon- 
ary infections before one would feel at liberty to make free use of 
Pane's serum. With anti-streptococcus serum satisfactory results 
have been achieved in some cases ; but it has been found that anti- 
streptococcus serum protects an animal only when such animal has 
been inoculated with the same variety of micro-organism as has been 
used to produce the protective serum. From this it would seem that 
we shall have to improve on our methods of determining the exact 
nature of the infection present before we can expect better results. 
The use of anti-toxin for tetanus has of late been attended by some- 
what more favorable results. In order to be of value, it must be used 
early and in repeated injections. 

In tuberculosis, we are still waiting for a serum which will offer 
some relief for this disease with which we can do so little. Probably 
as time makes us more familiar with the preparation, action and 
indications for the use of the therapeutic serum, we shall not restrict 
the use to curative medicine alone, but may go a step further, and 
place them among the preventive means. 



appendix to thk minutes. 73 

Address of the Third Vice-President. Typhoid 

Fever; its Relation to Water Supplies, 

WITH Observations Concerning its 

Treatment. 

BY E. 1.. B. GODFREY, A.M., M.D., CAMDEN, N. J. 

Typhoid fever is probably coeval with civilization, and is identified 
with the medical history of every country and of every clime. 

There are four epochs in its history, which distinctly mark the 
gradual evolution of its cause, its nature and its medicinal and preven- 
tive treatment. 

The first epoch occurred in 1813, when Bretonneau, of France, 
pointed out its enteric character; the second epoch, in 1829, when 
Louis, the great Frenchman, gave the fever the name it bears ; the 
third epoch, in 1836, when Gerhard, the illustrious American, estab- 
lished the symptomatic and morbid differences between it and typhus 
fever; and the fourth epoch, in 1880, when Eberth, the distinguished 
German, crowned the glory of his career in the discovery of the bacillus 
that acts as its exciting cause. 

The first, the second and the third epochs do not especially concern 
us ; but the fourth epoch has so revolutionized all former ideas con- 
cerning the cause of the fever ; its relation to public water supplies 
and its medicinal and preventive treatment, that I venture to bring these 
three factors to your attention, realizing, at the same time, that 
nothing new can be said on so old a subject. 

I.— THE CAUSE OF TYPHOID FEVER. 

The discovery by Eberth, in 1880, of a bacillus, or micro-organism, 
as the causative agent of, and a constant factor in, typhoid fever, 
marked an era in the progress of medicine. With the development of 
the science of bacteriology arid pathology, the relation that the Eberth 
bacillus sustains to the cause and course of typhoid fever has been so 
clearly demonstrated that practical and intelligent means can now 
be employed to combat its activities within the intestinal tract, and its 



74 MKDICAL SOCIETY OF NEW JERSEY. 

toxic products after absorption into the circulation. Special considera- 
tion, however, cannot be given to the bacillus in the brief time allowed, 
further than relates, in a practical way, to the management of the 
fever. 

It is known that the bacillus of typhoid fever is a constant factor in 
the course of the fever, and is now ascribed as its exciting cause : that 
the bacillus fulfills the law of Koch, in that it develops inside of the 
body, and grows outside of the body in a specific manner, under vary- 
ing thermal conditions. Entering the system through the stomach in 
food or drink, it grows and multiplies within the intestines and, by its 
activities and increase, it causes lesions in the glands of Peyer. with 
diarrhoea and tympanites, and produces various poisons known as 
"ptomaines, toxalbumin or typho-toxin." about which little is known, 
but which are absorbed into the circulalicn and create the condition 
of progressive toxaemia or septiccemia. The infection becomes general, 
and is attended with the phenomena of low blood pressure, enfeebled 
nerve-centres, and degeneration and wasting of the tissues of the body^ 
so characteristic of the fever. The bacillus passes from the system in 
the dejecta and the urine, from which the fever is disseminated ; 
grows and multiplies outside of the body, in water or cultivated soil, 
and retains a remarkable vitality under varying conditions of heat and 
cold. It is readily conveyed from place to place in milk, food, dust 
and water, the latter forming the chief vehicle of conveyance, and 
thereby becoming the subject of State and municipal inquiry. 

II.— RELATION OF JYPHOID FEVER TO PUBLIC WATER SUPPLIES. 

Typhoid fever is now regarded as a water-borne disease, and is the 
most common of all. Water is the main channel, both of its convey- 
ance and its propagation. Its prevalence and high death-rate in cities 
is acknowledged to be due to the dissemination of the bacillus in 
water supplies, though it is admittedly propagated in other ways than 
by infected water, especially in cultivated soil. 

Because of the liability of inhabited water-sheds, streams, springs 
and reservoirs to infection from the typhoid bacillus, and the con- 
sequent ingestion and dissemination of the bacillus among consumers, 
it is incumbent upon municipalities to protect water supplies from 
typhoid infection, or to secure water for domestic purposes from 
uncontaminated sources. The epidemic of typhoid fever at Plymouth, 
Pa., in 1885, which has become historic, proves this need, especially, 



APPENDIX TO THE MINUTES. 75 

when taken in connection with other epidemics. The protection of 
public water supplies by municipalities is a sine qua ncn of public health, 
and the absence of typhoid fever in a community is said to be the best 
test of *the purity of its water supply. Any data, therefore, that tend 
to the elucidation of this subject, are of value, and I venture to present 
a few facts and statistics concerning typhoid ftver in Camden, in 
relation to the past and present water supply of (hat city. 

Prior to April lo, 1899, the city of Camden was supplied with water 
from the Delaware river, which receives the drainage from Phila- 
delphia, Camden and various towns located upon its banks. The 
prevalence of typhoid fever in Philadelphia and Camden, led to the 
belief that the Delaware and its tributary, the Schuylkill, were con- 
taminated with sewage and infected with ihe typhoid bacillus. This 
belief, coupled with the discoloration and muddy appearance of the 
Delaware water, led to the sinking of artesian wells along the Dela- 
ware, about five miles north of Camden, as a source of supply for that 
city. The artesian system was eompleted and put in operation on 
April 10, 1899. Since that time. Camden has been supplied with pure 
artesian water at the rate of thirteen and one-half to fifteen millions 
of gallons every twenty-four hours, or about 200 gallons per capita 
per day, which is about 125 gallons per capita in excess of the amount 
furnished in a number of our chief cities. The result of this has been 
a marked diminution in the number of typhoid fever cases in the city, 
and the belief that the Delaware river water was the chief source of 
infection has been fully substantiated. 

The following statistics, collated from the records of the Camden 
City Board of Health, show the percentage of decrease since the 
abandonment of the Delaware as a source of water supply and the 
adoption of the artesian system, and indicate with great force how 
luxuriantly the bacillus of Eberth may thrive in a public water supply. 

These statistics cover two periods. 

I.— A period of five years from April 10, 1895 to April 10, 1899, 
during which the Delaware river water was the source of supply. 

II.— A period of one year from April 10, 1899, to April 10, 1900, 
when artesian water was used. 

These periods are contrasted in the number of cases, number of 
deaths, and percentage of decrease in the number of cases. The 
second period is compared with each year of the first period, sepa- 
rately and collectively, and each year is reckoned from April 10, as 
follows : 



76 



MEDICAL SOCIETY OF NEW JERSEY. 



FIRST PERIOD : 



YEAR. 



1894-5 
1895-6 
1896-7 
1897-8, 
1 898-9 



CASES. DEATHS. 

265 
279 



SECOND PERIOD : 



1 899-1900 



192 
60 



44 

24 
26 

17 
32 

12 



DEATH- 
RATE. 

I2.I 

9.0 

9.3 
S.S 

9-9 
20.0 



In comparing the number of cases in the second period with the 
number of those in the first period, per year, the following percentage 
of decrease of cases will be found in the second period : 

PERCENTAGE 
OF 

DECREASE. 

83.5 
77.4 
78.5 

68.8 
81.5 



FIRST PERIOD. 


SECOND 


PERIOD. 


1894-5. 


362 


cases 


.. 1899-1900. 


60 cases 


1895-6. 


265 


<t 


• 4 

• • 


t. 


1896-7. 


279 


<( 


• • • 


<4 


1897-8. 


192 


«i 


» • • • 


<< 


I 898-9. 


323 


li 

« • . 


4 4 

 • • • 


«< 



The average number of cases per year, for the first period of five 
years. 1894 to 1899, was 284.2. 

In comparing this yearly average with the number of cases in the 
second period, sixty, the percentage of decrease in the second period 
is found to be 78.9. The number of cases of typhoid fever in Camden 
has been reduced by 78.9 pef cent, since the introduction of artesian 
water about one year ago. 

The above figures prove to a certainty that, not only is the Dela- 
ware river a typhoid-infected stream, but that it has been the chief 
source of this infection for Camden in the past. 

Many thousands of Camden people find daily employment in Phila- 
delphia, where typhoid generally prevails, and drink the Schuylkill 
water, which is admittedly infected. Could this source of infection 
for Camden be eliminated, the percentage of decrease would be still 
greater in favor of the artesian supply. 

III. — THE TREATMENT OF TYPHOID FEVER. 



Time will not permit the consideration of the treatment of typhoid 



APPENDIX TO THE MINUTES. ^^ 

fever in detail. Attention, therefore, is only invited to a brief review 
of the following methods of medication, viz. : 

(a) Antiseptic treatment, or intestinal antisepsis. 

(b) Hydro-therapeutic treatment, or reduction of temperature by the 
Brand method. 

(c) Dietetic treatment, and re-enforcement of the nerve-centres. 

(d) Preventive treatment. 

(A) ANTISEPTIC TREATMENT. 

Intestinal antisepsis, as a form of treatment in typhoid fever, is now 
discredited by many distinguished authorities. Only the enthusiasts, 
it is claimed, believe the treatment affords specific results. With 
respectful deferejnce to all concerned, it can, however, properly be said 
to occupy a safe and middle ground between those who highly extol 
its merits, and those who believe that typhoid fever is not to be treated 
with drugs. 

This treatment is not claimed to be germicidal, but so improves the 
condition of the alimentary tract, that the bacilli are rendered less 
active ; their elimination in the dejecta is promoted ; the development 
of their ptomaines is retarded, and the degree of toxic absorption into 
the circulatory system is curtailed. 

There are two classes of patients to A'hom remedies admin- 
istered with this view, will early prove effective; those possess- 
ing an individual predisposition to the fever, and those who have 
recently become residents of a section in which the water supply is 
infected with the typhoid bacillus. Individual predisposition to typhoid 
fever is denied by some authorities ; but the family physician of long 
experience will recall numerous instances of individual and family 
predisposition to the fever, while the infection of new-comers in a 
typhoid district is a matter of common observation. 

In these two classes of patients, remedies that will both cleanse and 
disinfect the intestinal tract will prove of the highest value if admin- 
istered at an early stage of the disease. If the fever is detected during 
its prodromal stage, which frequently extends over a period of two 
weeks during which malaise with a foetid diarrhoea is its chief 
indication, and antiseptic remedies are persistently administered to the 
extent of modifying the diarrhoea, the tympanites, and the foetor of 
the dejections, the fever will be materially diminished in its intensity 
and curtailed in its duration, proportionately to the degree that septic 
infection is prevented. 



78 MEDICAL SOCIETY OF NEW JERSEY. 

There are two essentials that make the antiseptic treatment of 
typhoid fever successful. The first is an early recognition of the 
fever ; the second, the administration of antiseptics to the extent of 
overcoming foetid dejections and diarrhoea before the bacilli have 
implanted themselves in the patches of Peyer, causing lesions of the 
glands, absorption of ptomaines, and progressive septicaemia. 

This principle of antisepsis, or direct disinfection, when applied to 
diphtheria will modify that disease ; so, also, will it modify typhoid 
fever when early and systematically applied, but to a lesser extent, 
because the apphcations cannot be made so directly. As a matter of 
fact, it is the early recognition and the prompt treatment of typhoid 
fever that has caused the fever to run a milder and more subdued 
type generally throughout the country than was the case before the 
bacillus of Eberth was recognized as a factor in the disease. Bichlor- 
ide of mercury, calomel or salol. thermol. chloiine water or salicylate 
of bismuth, and other antiseptics will prove of therapeutic value when 
tympanites and foetid dejections are present. In the proportion that 
the bacilli are rendered less active, will these conditions be overcome 
and the fever alleviated. Disinfection of the contents of the aliment- 
ary canal is the test of the value of antiseptic treatment in typhoid 
fever. 

After the blood has become charged with the toxic and septic 
products of the intestinal lesions and of the bacilli, their elimination 
will be promoted by the regular administration of water for the 
purpose of increasing the blood volume, diluting its toxic elements, and 
removing them through the kidneys. Water, however, should not be 
given of a temperature to chill the stomach. 

Time will not permit further consideration of the antiseptic treat- 
ment, or the allied, symptomatic treatment of special conditions. 

(B) HYDRO-THERAPEUTIC TREATMENT. 

Persistent high temperature, with marked nervous disturbance and 
with exhaustion, indicates great danger to life. The partial destruction 
of the equilibrium between heat generation and heat dissipation ; the 
increased chemical changes within the body ; the derangement of the 
nerve-centres, and the progressive emaciation and loss of vital force, 
are sequences of progressive septic infection of the blood and nerve- 
centres induced by the typhoid bacillus. Since the bacillus can 
neither be destroyed within, nor wholly expelled from the system, 



APPENDIX TO THE MINUTES. 79 

after implantation in the glands of the small intestines, remedial 
efforts should be directed against the effects of the absorption of its 
ptomaines. At the present time, this seems to be best accomplished 
by means of the cold bath instituted by Brand. In hospitals, this 
method of treatment has supplanted the use of antipyretics, sponging, 
and the local application of guiacol in the reduction of temperature, 
and, when used in connection with the administration of intestinal 
antiseptics, it is the best method of treatment for typhoid fever now in 
vogue. 

A detailed description of the Brand method of treatment, as given 
at The Cooper Hospital, is as follows : 

The bathtub is placed beside the bed, and the patient, while in a 
recumbent posture, is lifted from the bed into a bath of 70° F., vigor- 
ously rubbed, except over the abdomen, cold compresses are laid 
upon the head, which is frequently sponged, stimulants are adminis- 
istered ; and, after about fifteen minutes, he is lifted out of the bath, 
placed in bed, rubbed dry, wra'pped in a blanket, and the temperature 
is taken to note the effect of the bath on the fever. Since the tem- 
perature is suddenly reduced by the bath, and frequently below 
normal, the patient should be closely watched until reaction is assured. 
The bath is repeated every three hours until the temperature is 
permanently reduced to 102.5® F , or less. The earlier the baths are 
given in the course of the fever, the more permanent their effects. 
Marked cyanosis, with a weak pulse, calls for close attention, if not 
removal from the bath ; but, neither pneumonia nor most complica- 
tions, except intestinal hemorrhages or marked cyanosis, contra- 
indicate its employment. 

The effect of the bath upon the fever is often marvellous, especially 
when nervous symptoms are pre-eminent. The bath will fre- 
quently quiet nervousness, remove delirium and induce sleep, when 
other measures fail. It not only quickly reduces the temperature to 
thenormal, or below it, but so stimulates the glandular action of the 
skin, the force of the circulation, the depth of the respirations, and the 
action of the kidneys, that the toxic and septic products of the blood 
are eliminated from the system through the increased action of the 
skin, the increased respirations, and increased urination. When early 
employed in the fever, not later than the fifth day, the administration 
of the cold bath will improve all the symptoms, modify the intensity 
of the fever, curtail its duration and accelerate convalescence, because 



80 MEDICAL SOCIETY OF NEW JERSEY. 

of the early and persbtent elimination of septic products from the 
hlood through its use. The treatment of typhoid fever by the Brand 
bath, coupled with the administration of intestinal antiseptics, has 
removed from the profession the old picture of typhoid fever. 

In a series of twenty-two cases treated at The Cooper Hospital, in 
which the Brand system with antiseptics was employed, and of which 
all recovered, the average duration per case, in the hospital, was 
nineteen days less than the average duration for the same number of 
cases preceding, treated without the bath. This method of treatment 
has reduced the death-rate in hospitals to about seven per cent., and 
affords better results than any other system now in use. the death- 
rate in private practice in the larger cities being about fifteen per cent. 
During the period from 1887 to 1900, there were 466 cases of typhoid 
fever treated at The Cooper Hospital, with a death-rate of seven and 
seven-tenths per cent. During the past year the death-rate from the 
fever has been two and five-tenths per cent, in that institution. 

The number of baths required varies greatly. A single bath is of 
comparatively slight value ; it is the frequent and continued employ- 
ment of the bath in the early stages of the fever that has so greatly 
reduced the death-rate. It is not necessary to wait for a diagnosis 
before beginning the use of the bath. 

Dr. James C. Wilson, of Philadelphia, directs his patients to walk 
from the bed to the bathtub during the course of the fever, and main- 
tains that this exercise tends to overcome the passive congestions and 
sluggish nutrition incident to continued recumbency. 

(C) DIETETIC TREATMENT. 

After specific toxaemia has taken place, the system requires dietetic 
support and re-enforcement of the nerve-centres, regularly adminis- 
tered. The chief consideration in the dietetics of typhoid fever, is a 
stated administration of the proper quantity of liquid food. The food 
should be given at regular intervals ; the quantity determined by the 
condition of the stomach and the digestion ; the kind, by selecting 
that which will leave the least residue within the intestines. In the 
majority of instances, milk is the best form of liquid food. In the 
early stages of the disease, it should not be administered in large enough 
quantities to tax the weakened digestion, a sequence of the fever; nor 
should it be continuously administered in its natural state during the 
height and the latter part of the fever, if curds are persistently found 



APPENDIX TO THE MINUTES. 8 1 

in the dejecta. When curds are found, milk should be peptonized or 
diluted with apollinaris or lime water, or wine whey or mutton broth 
should be substituted. Rarely are more than three pints required 
each twenty-four hours during the height of the fever; and milk 
should not be allowed to stand in the sick room, since it may serve as 
a medium for the development of bacilli without its appearance being 
changed. Frequent examinations of the dejecta for curds and foetor 
should be regularly made. The former shows enfeebled digestion ; 
the latter, a septic condition of the intestines, two factors in the 
typhoid state that should not be overlooked. 

The re-enforcement of the nerve-centres in typhoid fever may be 
best accomplished by the use of fresh air, strychnia and stimulants, in 
addition to dietetic support. Because of prolonged recumbency and 
enfeebled respiration, the typhoid subject requires at least twenty-five 
per cent, more fresh air than a healthy adult. Strychnia, as a remedy 
for re-enforcing nerve-centres when exhaustion is present, as indicated 
by irregular or enfeebled heart action, muscular twitchings, distended 
abdomen and cold feet, stands unsurpassed when administered 
regularly and hypodermatically, and alcoholic stimulants are of equal 
worth when the first sound of the heart indicates failing circulation. 

(D) PROPHYLACTIC TREATMENT. 

Every case of typhoid fever, with few exceptions, results from the 
ingestion of the Eberth bacillus in food or water. Dust, also, may act 
as an agent for its dissemination. The manner of entrance of the 
bacillus into the system, and of its exit from the system, point to 
certain prophylactic measures that should be employed in the 
management of the fever. Thorough disinfection of the stools, 
urine and vomited matter, during both the febrile stage and 
convalescence, is essential to the proper supervision of a 
typhoid case. The disinfection of the urine is as important 
as the disinfection of the stools, especially when the urine 
is albuminous, indicating nephritis. Absolute cleanliness of the 
patient, the attendants and the bedding and appliances of the sick 
room, obtained by application of antiseptic solutions, is also essential, 
the details of which, however, all are familiar with. The necessity for 
these precautions is admitted, but the thoroughness with which they 
are carried out frequently marks the difference between success and 
failure in the treatment of typhoid fever. 

If typhoid fever is admitted to be a preventable disease, then failure 
to properly employ prophylactic measures in its management throws 

6 



82 MEDICAL SOCIETY OF NEW JERSEY. 

the responsibility of its prevalence in an endemic or epidemic form upon 
the attending physician, as well as upon the municipal authorities. 
The medical profession owes it to the community to exercise the most 
thorough supervision over the disinfection of the discharges from the 
typhoid subject, since only by bringing the disinfecting solution in 
actual contact with the bacilli will it prove effectual. The historic 
epidemic of typhoid fever at Plymouth, Pa., in 1885, in which, from 
one case of the fever, twelve hundred persons became infected, is a 
powerful witness to the need of thoroughness in the employment of 
disinfecting measures in the management of typhoid fever. Corrosive 
sublimate (1-500) will prove an effective germicide, and should be left 
in contact with the dejecta for two hours, and continuously employed 
for at least ten days after the temperature has returned to the normal. 

Relatively considered, the profession shares with the municipality 
the responsibility for the continuance of t)phoid fever in an endemic 
or epidemic form. Under such circumstances, the condition of the 
water supply should be made the subject of official inquiry, since 
water is the element in which the Eberth bacillus best thrives. 

The specific form of treatment for typhoid fever, in which immunity 
is produced, by injecting sterilized cultures of the bacillus as a pre- 
ventive measure, is now under trial, and gives reasonable assurance of 
great value. The time may not be far distant when serum-therapy 
will become the accepted treatment for this disease 

In closing this brief paper on typhoid fever, it is evident that many 
of its salient points have not been touched upon. There are three 
important facts, however, to which your attention is again directed. 

1. The discovery of the Eberth bacillus has placed typhoid fever 
among the preventable diseases, and has, therefore, thrown the 
responsibility for its prevalence upon both the profession and the 
municipality. 

2. The close relation of endemics of the fever to the condition of 
the water supplies, is clearly and forcibly shown by the statistics pre- 
sented from the Camden Board of Health. 

3. While the present methods of treatment, medicinal, hygienic and 
sanitary, are more rational and effective than any that have preceded 
them, in combating intestinal lesions and systemic infection, there is, 
nevertheless, no drug, remedy or method of treatment known at this 
time, which will destroy the bacilli within the intestinal tract, or act 
as a direct antidote to their poisons or ptomaines within the blood, 
unless it should prove to be the treatment by injections of sici ihzcd 
cultures of bacilli, which is still in the experimental stage. 



PRESIDENTS ADDRESS. 

BY L. M. HALSEY, M. D.. WILLIAMSTOWN, N. J. 



Fellow Members of the Medical Society of New Jersey : 

Looking backward one hundred and thirty-four years, to the time of 
the organization of the Medical Society of New Jersey, and the long 
list of distinguished men who have so ably filled the position of its 
presiding officer, I have approached the time with considerable timid- 
ity when I should preside over your deliberations. Each person is 
more cognizant of his own frailties than any one else and I fully 
appreciate my unfitness to act in such a capacity over this learned 
and scientific body. But I trust, with your hearty co-operation and 
kindly forbearance, to accomplish it satisfactorily. The Medical 
Society of New Jersey, with the prestige of over a century of exist- 
ence, and the name of being ever to the front in every advance in 
medical science, with men enrolled bfneath her banner as practition- 
ers of medicine second to none in this broad land, confers upon one 
of her number the highest honor in her power to bestow. The recip- 
ient should feel profoundly grateful ; it should incite him with a sincere 
desire to creditably perform the duties which such an exalted position 
demands. I feel very grateful for the honor and the many kindnesses 
that my medical brethren have accorded me. 

In all the domain of medicine to-day there is no subject which is so 
prominent and is so universally attracting the attention of the profes- 
sion as the prevention and treatment of tuberculosis. When we con- 
sider that one-eighth of the total mortality from all diseases is caused 
by this dreaded monster, certainly no disease has so great a claim 
upoh the devotion of our energies and none should have more honest, 
concerted action for its suppression. In the State of New York in 
1898, 12,979 persons died of consumption, and of this number 7,72$ 
were inhabitants of the city. When the soldiers were going to the 
Spanish war it was a common sight in New York to see regiments 
march down Broadway. Imagine one of these regiments smitten 
with some mysterious malady and falling in their tracks before reach- 

* Our Duty as Physicians to Consumptives. 



84 MEDICAL SOCIETY OF NEW JERSEY. 

ing the place where they were to embark. The horror of such a 
situation cannot be expressed. But in the United States annually 113 
regiments drop out of life through the onset of a preventable disease. 
A disease which does not kill with the rapidity of a bullet, but which 
has a long, silent and stealthy period of incubation after the fatal seed 
that produces it has been planted in its victim. Certainly it seems to 
have been demonstrated that consumption is contagious, this one of 
the great triumphs of the nineteenth century, and there is much ground 
for hope that the twentieth century may see as nearly the eradication 
of this dread disease as the past century did of smallpox through vac- 
cination. It is a curious coincidence of statistics that the proportion 
of people who die in all civilized countries, is just about the same as 
those who died of smallpox in the early part of the eighteenth cen- 
tury. Before we can conscientiously promulgate a plan looking to the 
abolition or limitation of any malady a careful study must be made of 
the cause, or at least of the conditions under which they become vigor- 
ous, as well as those in which they are dormant, or exterminated. A 
careful study of the etiology of any disease is the only sure ground for 
its prevention and extermination. A conscientious and painstaking ex- 
amination into the conditions which favor the development of tuber- 
culosis has clearly proved that the disease is much more virulent in 
persons of sedentary habits, and with those whose occupations keep 
them closely confined in badly ventilated buildings. Damp dwellings 
on badly drained land are breeding spots for this disease. Excessive 
indulgence in alcohol and continual mental depression are also promi- 
nent factors. In all institutions where the inhabitants are greatly 
restricted as to fresh air, as jails, barracks, convents, the deaths from 
tuberculosis are alarming. In the statistics of thirty-eight convents, 
with an average number of inmates of 4,028, there occurred 2,099 
deaths in twenty-five years from tuberculosis (62.88 percent.). In 
some instances, more than three-fourths of the deaths are from this 
cause. Cornet states that nurses are particularly prone to this dis- 
ease ; statistics which he gathered in one hundred cases of deaths of 
nurses sixty-three died of tuberculosis. Statistics of the Alabama 
Insane Hospital for three years show a death rate of 28 per cent, among 
the whites and 42 per cent, among the negroes from tuberculosis. 
Baer contends that the mortality in prisons is four times as great as 
outside. In most penal institutions the mortality is from 40 to 50 per 
cent., while in Austria it is as high as 60 percent. The high mortality 



APPENDIX TO THE MINUTES. 85 

is undoubtedly caused by mental depression, lowered vitality, lessened 
power of resistance, the presence of bacilli, and no systematic system 
of prophylaxis to prevent their propagation. It has been conclusively 
demonstrated, that the more perfect the prophylaxis and hygienic 
conditions the mortality is surprisingly reduced. Dr. Flick, of Phila- 
delphia, who has made an exhaustive and life-long study of this 
disease, contributes an interesting paper on the distribution of tuber- 
culosis in a single ward in Philadelphia for a period of twenty-five 
years. He clearly demonstrates that during this time one-third of the 
houses became infected, and more than one-half of all the deaths in 
one year (1888) occurred in the foci of infection. Of the infected 
houses not 10 per cent, were isolated; 33 per cent, of the infected 
houses had more than one case. These two conditions would seem 
to warrant the conclusion that consumption is contracted by contact, 
association, or by living in close proximity. Flick contends that con- 
sumption follows very intimately the first law of contagious diseases. 
In a comparison of his diagrams of smallpox, diphtheria, typhoid 
fever and phthisis, the groupings are practically identical. He calls 
attention to another marked feature of contagious diseases. After 
having used up all the available matter in a given locality, it dies out 
to make its appearance again when the soil is in proper condition for 
its redevelopment. This may be termed a law of self-limitation, pro- 
ducing cycles of diseases; when the hygienic conditions are ripe 
producing scourges. Self extinction of a disease is regulated by its 
duration. As a rule, contagious diseases are rapid in their course 
and the epidemics are consequently short. The course of consump- 
tion being lengthy, it is comparatively an easy matter for the infection 
of all susceptible persons from one individual ; this lengthens very 
materially the epidemics of phthisis. In Flick's cases the average 
time was three years. Series of endemics dovetailing into each other 
give the country at large the appearance of a continual epidemic. A 
careful inquiry into these facts show thiat the large epidemics are pro- 
ducts of numerous small endemics. One of the most marked factors 
in influencing infection is undoubtedly environment. Residents of 
cities are much more liable to the disease than those living in the 
country. 'I he liability to infection being greater, the powers of resist- 
ance are less active. Tenement houses, dark alleys, poorly ventilated 
houses and workshops, and the absence of that great destroyer of the 
bacillus, /. e., sunlight, demonstrates that environment has much to 



86 MEDICAL SOCIETY OF NEW JERSEY. 

do with the propagation of this disease. The experiments of Tru- 
deau admirably illustrates this ; rabbits innoculated with tuberculosis, 
if confined in dark, damp places without sunlight rapidly succumb, 
while others treated the same and allowed to run wild either recov- 
ered or developed very slight lesions. Further statistics exemplify 
this, the number of cases of tuberculosis in fifty neighborhoods, 
where the outside and inside hygienic conditions were bad, were 
largely in excess of other localities ; under these conditions a lowered 
vital resistance results a prominent factor in developing tuberculosis. 
We must not only study the bacillus, but the chemical constitution of 
solids and fluids, as perverted by its action. Under these changes the 
tissues become fertile ground and a promising culture medium for the 
tubercle bacillis. The condition might properly be termed a diathesis 
or susceptibility ; a radical change from the normal healthy conditions 
is unquestionably a diseased condition and a marked factor in the 
morbid changes of tuberculosis. While sufficient evidence can be 
produced to demonstrate that the bacillus is harmless when man's 
vital resistance is at par, in perfect health he is immune to its attacks ; 
it only becomes effective in the production of diseases when the 
normal standard of vital resistance has become defective from other 
causes. M. Jaccoud well defines this. The tubercle bacillus belongs 
to a group of pathogenic microbes, called etiological dualisms, be- 
cause they may exist in healthy organisms an indefinite period without 
injury to the latter, and become noxious only in consequence of changes 
in the organism itself from other influences. In reference to this class 
of microbes, he says : ** Pathogenisis, by changes in the organism is 
the rule, and the traditional etiology based on heredity, congeniality, 
predisposition, constitution, temperament, or on somatic or cosmic 
influences, retains all its force. These multiple and variable elements 
are the true cause of disease, the microble only the instrumental 
agent." Under such stipulations, a logical conclusion that the work 
of physicians in eradicating tuberculosis is in restoring impaired and 
imperfect conditions, remove defects and bring the vital resistance to 
a natural standard. These provisions make it impossible for the 
microbe to develop and produce disease and death. Baumgarten 
asserts that the tubercle bacillus can lie dormant in the tissues and 
later develop, but he qualifies this with the statement that the cause is 
generally a lowered individual resistance. The question of dormancy 
|;ias been clearly stated by Fowler, /'. /., that it was not necessary seri- 



APPENDIX TO THE MINUTES. 87 

ously to consider the question of latency in tubercalosis, until direct 
transmission from mother to child was proved to be of frequent 
occurrence. The most conservative authorities admit the intertrans- 
missability of bovine and human tuberculosis. It is more readily 
transmitted from cow to man than vice-versa, because the optimum 
of temperature of the bacillus (99® F.), is nearly the normal temper- 
ature of man. while the cow's temperature (about 102® F.) is above 
the optimum of the germ. The germ is nearly a purely obligatory 
parisite ; its existence outside the animal body is beset with so many 
difficulties, that the observation made that cattle pastured on fields 
frequented by consumptives did not contract the disease, proves noth- 
ing. 

There is a strong probability that the bacillus of avian turbuculosis 
is the same germ altered by heredity and environment, its difference 
in size should count for but little, as the morphology of bacteria is one 
of their most inconstant features, and their is no reason why a low 
organization should not finally triumph against the difficulties offered 
to its acclimitization, /. e,, the temperature of the bird (about 110° F.). 
as we know many of the higher plants have done. The chrysanthe- 
mum was imported into France from China in 1790; until 1852 it re- 
fused to seed ; in that year a few plants produced fertile seeds and in 
1872 France raised all the seed she needed. The plant had become 
acclimated. Nocard claims that avian and human tuberculosis are 
varieties of the same species, points out these differences, (i), in the 
aspect of the cultures, dry and warty in the human, fatty, shining and 
soft in the avian ; (2), in the upper temperature limit for the growth of 
the bacillus, above (42 C) for the human, above (44 C) for the avian, 
and (3) in the results of innoculation in animals. Fowls resist human 
injections, but not avian. Dogs are susceptible to human, but not 
avian ; guinea pigs to human, but not avian. Rabbits suffer equally. 
The horse is difficult to innoculate but develops two forms, the ab- 
dominal and pulmonary. This would seem to indicate two forms of in- 
fection, the bacillus from the pulmonary form, resembling human tuber- 
culosis, the other the avian type. Nocard contends that man is suscep- 
tible to both these forms. He has demonstrated that experimentally 
by transforming the one into the other. An important point in the 
etiology of tuberculosis is the mode of entrance of the bacillus into the 
economy, a solving of this factor makes the question of prophylaxis 
more easy. The mode of ingress is (ist), by the lungs ; (2d), by the ali 



88 MEDICAL SOCIETY OF NEW JERSEY. 

mentary canal ; (3d), by innoculating the skin. In the first way, cither 
by bacilli entering through the follicles of the tonsils, then passing down 
through the cervical chain of glands and the lymphatic vessels into 
the chest, or that the bacillus is carried into the bronchial glands, 
when it is taken in by the respiratory tract and does not have its pri- 
mary seat in the lung. It is questionable whether the cases in 
which the lung tissue is first involved have not been infected through 
the alimentary canal. While much interesting work has been done in 
this field, the trend of opinion is strongly that the stomach is most 
frequently the avenue of entrance of the bacillus. The question seems 
to be settled only so far that undoubtedly the bronchial glands are the 
primary seat of tuberculosis when the bacilli are carried in by the lungs. 
How frequently the bronchial glands may be the primary seat is diffi- 
cult to determine, because a small diseased gland may produce no 
symptoms, and the first thing which attracts our attention may be a 
secondary inflammation in the lung tissue. (2). The alimentary tract 
being the ordinary mode of entrance into the economy of foreign mat- 
ter, its construction and mechanism all conform to the rapid transfer- 
ring of matter from without into the body. Its purpose is to supply 
the economy with nourishment, and when in a normal condition dis- 
criminates readily between good and deleterious matter. In the 
mechanical process of transferring food into the body, micro-organ- 
isms and parasites of all kinds get in, and unless they are destroyed or 
rendered inert by the stomach will be taken into the system, and if a 
congenial soil is found develop and multiply rapidly. It seems to be a well 
established fact that a predecessor of phthisis is a deranged stomach- 
When the stomach becomes deranged it is unable to destroy the 
bacilli, which passes uninjured into the intestines, from which it is 
absorbed by the lactaels into the thoracic duct and carried into the 
circulation. The fact that the most frequent sites for the development 
of tuberculosis — the apex of the lung and in children the intestinal 
tract and membranes of the brain, or in the most distant parts of the 
body, — can readily be exemplified by the supposition that the bacillus 
gains its entrance through the stomach. The contents of the thoracic 
duct, intermingling with venus blood, is carried into the lungs, it is 
readily seen that a larger number of. the bacillus enter the lungs than 
any other organ. We know that the blood has a phagocytic influence 
over bacteria ; it can readily be seen that as the bacillus progresses in 
the circulation many die, and the nnore remote any organ from the 



APPENDIX TO THE MINUTES. 89 

entry of the contents of the thoracic duct there is a lessened chance of 
its infection. As the brain, intestines and abdominal organs are the 
largest recipients of arterial blood, we would infer that they would be 
the most frequent seat of tubercular infection. This has been conclu- 
sively demonstrated in practice. While the number of bacilli entering 
an organ is not the only thing to be taken into consideration, the con- 
dition of the soil is an important factor ; any interference in the active 
circulation of an organ is a predisposing cause, consequently the apices 
of the lungs, congested membranes of the brain of teething children, 
the irritated alimentary tract of bottle-fed babies, are the proper soil 
for the development of the tubercle bacillus. 

The deduction can readily be drawn that the non-occurrence of 
tuberculosis in persons exposed is due to the bacillus destructive 
power of a normal stomach, and to the phagocytic power of the blood. 
The conditions necessary to contract the disease are (ist), contact with 
infected persons, or objects, to allow the bacillus to enter the stomach ; 
(2d), a stomach so disordered as to be unable to destroy the bacillus, 
but allows it to be taken into the circulation ; (3d), localized places of 
sluggish circulation, which offers a congenial area for the development 
of the bacillus. 

The determination of the infective nature of consumption, and the 
condition of its activity constitute by far the most important results of 
Koch's investigations, more especially in relation to public health, 
since it is from a knowledge of the conditions under which the infec- 
tive properties of the bacillus become effective, that indications are 
fnrnished as to the means and measures by which the tubercular dis- 
ease thus produced is to be effectively prevented. The main facts are 
these : 

(ist.) That consumption is an infectious disease, due to specific 
micro-organism. 

(2d.) That the tubercle bacillus is the essential infective element. 

(3d,) That this microbe is contained in the sputum of affected 
persons. 

(4th.) That therefore the sputum must be regarded and treated as 
the vehicle of infection. 

(5th.) That the bacillus i^etains its vitality when dried for unascer- 
tained periods and at low temperatures, but its activity is destroyed 
by free exposure to fresh air, by bright sunlight in a short time, and 
by the usual antiseptics. 



90 MEDICAL SOCIETY OF NEW JERSEY. 

(6th.) That we are not positive that the bacilli are exhaled by the 
breath. 

That certain conditions must be presented before the infective ele- 
ment, the. bacillus, can initiate the morbid process. 

(ist.) The existence of a predisposed type of constitution, or an 
acquired state of lowered vitality. 

(2d.) Access to the lungs by the bronchial glands, tonsils and post 
nasal tissue. 

(3d.) The pulmonary tissue must be degraded to a lower vitality, 
either by mal-nutrition, or previous inflammatory attacks. 

(4th.) The tubercle bacilli must have access to this favorable soil 
by the above mentioned ways, possibly inhalation and undoubtedly 
by the stomach and circulation. 

These conditions seem to pave the way properly for prophylaxis. 
We recognize that tuberculosis is essentially parasitic in nature and 
form, and that it obeys the well-known laws of parasitism. While it 
is local as to cause, the absorption of the by-product of the bacillus 
develops coiistitutional symptoms, and fatal results ensue as a result 
of the absorption. While nature makes a great fight to destroy para- 
sites, the way in which it is accomplished, /. /., breaking down and 
casting off of the tubercular nodule, may be the means of expanding 
the malady. It seems self evident that most cases of phthisis would 
recover if there were no possibility of auto-infection ; certainly it is a 
great exception that the primary ingress of the bacillus has a fatal 
effect. In a large majority of cases, it is a protracted number of 
imbibations of the bacillus in which each new ingression is the mani- 
festation of a previous abortive effort at restoration. 

This explains the long course of tuberculosis, and the availibility of 
its duration in different subjects. If the power of resistance is excel- 
lent the ingressions are mild, the destructive process less rapid and 
lengthening the time between invasions. Environment, habits of the 
subject, are marked factors in deciding auto-infection, and, as a con- 
sequence, the length of the malady. While auto-infection cannot be 
entirely prevented, it can to a marked degree be restrained, and the 
destructive process decidedly controlled. Auto-infection may be 
largely checked, first by building up the economy, enabling it to resist 
new deposits and by preventing the readmission of organisms into the 
system. For this building up of the system every means must be 
developed, the food supply, assimilation and elimination systematically 



APPENDIX TO THK MINUTES. 9I 

examined and rectified where wrong, so that it may be possible to 
obtain the greatest amount of nutrition from the least expenditure of 
force. A marked factor in auto-infection is the careless or ignorant 
way consumptives have of disposing of their expectorations. He must 
be instructed in the danger, not only to himself but others, in expec- 
torating anywhere. The danger of reinfecting the upper air passage 
by dried sputum on a handkerchief is beyond question. Consumptives 
should never expectorate in a handkerchief, but always in a proper 
receptacle, of which there are various kinds, from the pocket flask, 
which is readily cleaned, and the cardboard box, or Japanese paper 
handkerchiefs. Both of the latter of course should be burned after 
use. If the handkerchief is used, the patient should be instructed to 
have a removable rubber-lined pocket, which may be readily cleansed, 
always observing the precaution to wash the hands before eating, to 
prevent infection. If these facts are well established, what use can be 
made of them by physicians to stamp out consumption, and how can 
it be accomplished in the briefest time ? Knowing the origin of the 
disease, and its manner of infection, we should know the way to con- 
trol it, without oppression, making life more pleasing, and vastly 
increasing the chances of recovery. 

The first essential is a more complete education upon the contagious 
nature of the disease. The medical man of to-day, educated in the 
laboratories, will have a complete knowledge of the nature of tubercu- 
losis, but this does not affect the laity. The entire community must 
be educated as to the correct idea of the malady. The community 
has unfortunately taken the idea of contagion from the abstract of 
the same nature as smallpox, but the method of contagion is so radi- 
cally different that unless you educate them as to the correct nature of 
the contagion of tuberculosis, it will be difficult to accomplish any- 
thing. No new case can develop without an old one to spring from. 
The disease is due to direct or indirect personal contact, and therefore 
the environment in which it is contagious is much more restricted than 
that in which smallpox is contagious. The exposure to tuberculosis 
must be of a much longer duration. Contact is absolutely necessary. 
No more unfortunate or erroneous idea ever existed in the profession 
than that of the ubiquity of the tubercle bacillus. There is no such 
thing as the ubiquity of the tubercle bacillus. While it is true each 
individual consumptive ejects millions of bacilli, and while there are a 
great many consumptives, it has been proven that after they are sub- 



92 MEDICAL SOCIETY OF NEW JERSEY. 

jected to the influence of the air and sun that the life of the bacilli is 
exceedingly brief — in fact, the bacilli ejected into the street, or places 
where we congregate, has a life of but short duration. Should we be 
exposed it is not in a way to produce successful innoculation. It 
requires a close and intimate association, covering a considerable por- 
tion of time, to produce innoculation, as in the case of those who 
occupy the same room occupied by a consumptive, or handle the same 
utensils, or eat out of the same dishes, or those who live in close per- 
sonal contact with the patient. The contagion of tuberculosis is 
directly limited to an environment of that nature. P2ven in a room 
occupied by a consumptive for a long period of time, when the envi- 
ronment is restricted in other points, the area in the room in which 
successful innoculation can take place is more intense as you approach 
the bed the consumptive occupies. If the idea of the ubiquity of the tu- 
bercular bacillus were done away with the solution of this portion of the 
tubercular problem would be more readily solved. One of the most im- 
portant measures for the stamping out of tuberculosis is to make it a 
notifiable disease, all cases should be reported to the Board of Health 
and give the boards full power to act. This is unquestionably true 
among those who, by reason of carelessness, ignorance and want, are 
the most exposed, and must subject others to the dangers of infection. 
This is necessary in the interest of the patient and the community at 
large. Delay is most disastrous to consumptives. During the incip- 
ient stage, a cure is almost a certainty. How can we ever hope to 
take the steps to prevent and eradicate this disease which, though 
more slow, is no less certainly destructive than the disease already 
notifiable. Is public opinion not ripe for such an advance ? Are we 
too previous in our attempts to save lives ? Notification will be a long 
step forward in the battle against this disease. Countries who are 
leading the van in this direction are making rapid strides in check- 
ing this malady. Let the State take it up ; give us a plain, simple 
law, and I am convinced we shall see excellent results. 

If we know where consumptives dwell, we can exterminate the 
bacillus and give them valuable aid. Often so poor and broken down 
that they cannot buy the necessary medicines, and have not sufficient 
energy to take any interest in life, if the proper authorities know these 
houses, they can take the steps to prevent the spread of the disease ; 
show these people you have come to protect and help them without 
gain, and they become your friends. It is no hardship, but the great- 



APPENDIX TO THE MINUTES. 93 

est blessing ; they will learn how to prevent conveying the disease to 
their families. What can we do to protect people from the invasion 
of the tubercle bacillus ? One of the principal factors in producing 
consumption is deficent air supply ; any improvement in this condition 
is a stimulant to the vasomotor system, causing increased energy. As 
soon as the child is of proper age, it should be taught breathing exer- 
cises ; these with gymnastics should be incorporated in the curriculum 
of all schools. Teach them how to sit, stand and walk properly. Dr. 
Hitchcock says : •' There is no doubt that if as much care was be- 
stowed on our young in seeing that the thorax was developed, with 
that care that the brain receives, tuberculosis would entirely disappear." 
Sanitation should be taught in all our schools ; proper care of slates 
and books, and the careful sweeping aud disinfecting of the floors- 
Systematic sanitary instruction for the children will have a wonderful 
effect in the years to come ; while it costs so little to prevent the 
spread of disease in schools, it may require an enormous outlay to re- 
pair the damage done by germs. This question of sanitation in our 
public schools is a most vital one, and should be rigidly taken up by 
our State authorities, thereby educating the children to a higher stand- 
ard of physical development and in a proper condition to begin life's 
work. 

Hydrotherapeutics is a valuable measure in preventing tuberculosis 
and should be instituted at an early age. A careful consideration of , 
the skin is very essential in the treatment of the disease. The patient 
should take his hygienic baths once or twice a week, followed by a 
rapid sponging with cold water. The tonic effect of air and sun 
baths on the cutaneous surface is of marked benefit. A careful 
watching of all cases of eruptive fevers, they too frequently leave the 
patient with a predisposed condition favorable to the inroads of the 
bacilli. 

The medical treatment of consumption is largely special or sympto- 
matic, as every other disease, characterized by dangerous symptoms, 
requiring strict clinical treatment ; the main feature is the treatment 
of each case according to its individuality. So much has been said 
pro and con about tuberculin, it would seem proper to investigate its 
value as a factor in the treatment of tuberculosis. Its diagnostic value 
cannot be disputed, in the lower animals; it has given definite and 
useful results. 

The histologic changes caused by tuberculin injections were early 



94 MEDICAL SOCIETY OF NEW JERSEY. 

observed by Virchow, who opposed the clinical use of it almost as 
soon as suggested, arguing that this hyperemia, by producing macer- 
ation and softening of the tubercles, might easily be the cause of the 
liberation of the tubercle bacilli from tubercles in progress of recovery, 
or might greatly facilitate the spread of the disease in ordinary cases, 
thus hastening the fatal termination. Virchow supported this idea by 
a mass of evidence collected upon his own and other autopsy tables. 
While there are many adherents to the use of tuberculin in the treat- 
ment of consumptives, it is not founded upon any well-grounded 
principle, and its action is contradictory to what is known of the mate- 
rial. The original bases upon which the tuberculin treatment were 
founded were the suppositions that it was the essential toxic element 
of the tubercle bacillus and that the continual and gradual injection 
would produce immunity. It was also claimed that the hyperemic 
reaction was due to its effect upon tuberculous matter assisting in 
granulation and cicatrization of the tubercles. These presumptions 
have been proven to the contrary by numerons bacteriologists, who 
have carefully worked up this subject. Immunity is not produced to 
the tuberculous infections by injections of the tuberculin. It has not 
had any marked effect in the prolongation of animals' lives. The tu- 
berculin is positively without an) effect upon the tubercle bacillus, 
which it neither destroys or modifies in virulence. The hyperemia 
induced by contact of the tuberculin in the blood and the tubercle 
does not favor cicatrization, but predisposes to the further distribution 
of the bacilli by softening the tissues in which they are growing. Dr. 
Ambler tersely expresses the proper status, when he says: ** Do you 
believe you would carry out such a procedure in your own person 
under such possibilities ; if you would not, you have no right to use it 
upon your patients." The use of tuberculin even by its radical adhe- 
rents is generally recommended under the following restrictions : 

Not to be applied in advance cases. 

Not to be applied in mixed infections. 

Not to use it as an exclusive remedy, but always in connection with 
the best hygiene and the best of diet. 

Not to neglect the symtomatic treatment. 

Results are : 

A large percentage of incipient cases are cured. 

A small percentage of advanced cases are benefited. 

A still smaller percentage remained indifferent to treatment. 

A very small percentage died. 



APPENDIX TO THE MINUTES. 95 

Are not the results as good with the general practitioner or sanita- 
rium physician, whenever the hygienic, dietetic, symptomatic and 
educational treatment are c<3nscientiously carried out ? No treatment 
can succeed which does not have for its fundamental basis the rebuild- 
ing of a weakened system by judicious hygienic and dietetic measures. 

In the treatment of consumptives two of the most important features 
are hygiene and nutrition. In the matter of dress, it should be com- 
fortable and according to the weather, always avoiding excessive 
clothing, as chest protectors, additional undershirts. These are fre- 
quently the cause of contracting colds, they make the individual super- 
sensitive. As much time as possible should be spent in the opcrn air 
the windows of his room should be open at all times, summer and 
winter ; if he teels the cold put on more bed-clothes. He should have 
a bedroom to himself, and have at least nine hours sleep. 

The quesiion of nutrition is of such vital importance that many 
sanitaria have adopted the plan of forced feeding, claiming that the 
best cure for indigestion is increased feeding. Many cases could be 
cited in which the whole digestive apparatus was working insufficient- 
ly, the symptoms being entirely eradicated by this plan — good, nour- 
ishing food given at such intervals as to be properly assimilated. The 
improvement of nutrition is the key to the situation. Dependeivt for 
inception upon a previous state of malnutrition, it develops further loss 
of appetite, dyspepsia and Wasting, allowing the tubercular process to 
advance to a firmer footing. 

The proper education of consumptives is of great importance. Some 
are over-careful ; others extremely careless. Some sanguine; others 
morose. These are all matters of prime importance. 

The most fertile source of infection is from the sputum, which, when 
dried, finds an entrance into the body. Therefore all patients must 
destroy the sputum before it passes from their control. The following 
suggestions will be helpful, as formulated by Dr. F. W. Reilly : 

1. At home, expectorate into a cup kept for that purpose. This 
cup should be half full or three-quarters filled with a solution consist- 
ing of one part of carbolic acid to twenty of water. Burn the contents 
and boil the cup. 

2. Never expectorate into a pocket handerkerchief or cloth which 
will be allowed to dry. Keep the sputum wet, and best with the above 
solution. Soak handkerchiefs in the same and immerse them in boil- 
ing water before storing them with the soiled linen. 



96 MEDICAL SOCIETV OF NEW JERSEY. 

3. For use on streets, or when away from home, let the patient be 
provided with thin Japanese napkins. 

4. Do not spit where domestic animals have access to this matter. 
Cattle and fowls are very susceptible and become in turn sources of 
infection. In fact, do not spit at all where sputum is not destroyed. 

5. Do not spit on streets, and never swallow the sputum. 

6. No tuberculous person should kiss anyone on the mouth. 

7. Tuberculous patients should be smooth shaven. It is not possi- 
ble to keep a beard clean and from being infected. 

8. The tubercular must always sleep alone. 

9. All bed clothing should be changed often— every day when the 
case is far advanced — and should be at once immersed in boiling 
water for five minutes. 

10. Have separate table utensils and cause them to be scalded as 
soon as used, and washed separately. 

11. Do not permit others to use a patient's personal property. 

12. A tuberculous mother must not nurse her baby nor kiss it on 
the mouth and, in preparing its food, must observe special care. 

13. Tuberculous persons should not engage in occupations where 
they are compelled to handle food supplies. If this is unavoidable, 
use every precation to prevent infection. 

14. There is no need of isolating patients nor of depriving them of 
a single home comfort. 

Next he gives a few directions to those who would avoid contracting 
the disease : 

1. Avoid resorts devoted to the treatment of the tubercular. 

2. Summer and winter, women must wear skirts that clear the walks 
by not less than four inches, and five or six would be better. Avoid 
all kinds of fur or soft trimmings around the lower part of dresses. 
Note the filth, especially the sputum, on sidewalks. Skirts dragged 
through this are taken home, dried, brushed and cleaned, and then 
infection is introduced into the household. 

3. Do not move into a house where your predecessor was tubercu- 
lous, without an efficient disinfection of the premises. To secure such 
disinfection have the walls cleaned of old paper and wash with a solu- 
tion of mercuric chlorid, i to 1000. The woodwork should be painted 
after cleaning with this solution and all the floors thoroughly saturated 
with it. 

4. Do not share a consumptive's bed nor use the personal property, 
including dishes, belonging to one. 



APPENDIX TO THE MINUTES. 97 

5. Avoid tuberculous foods. Fowls and cattle are found to be 
especially susceptible of tuberculous infections. However, when food 
is thoroughly cooked infection is destroyed. Milk, especially that for 
children, must be from cattle free from infection. By heating it to 
180^ F., for half an hour, it becomes non-infectious. 

6. Never put coins or other money in the mouth. 

7. Never use a pipe or wind instrument belonging to a consumptive. 

8. Probably the most important of all is to see that the digestive 
functions are kept in perfect order. Dyspepsia is more often a fore- 
runner of tuberculosis than any other disease. The secretions of a 
healthy stomach will dispose of a large amount of infected material, 
but when diseased, the stomach is the principal avenue of infection. 

9. Spend as much time in the sunlight and open air as possible. 
Keep sleeping and living rooms well aired and filled with sunlight, 
which acts as a powerful destroyer of the gferm, 

10. If possible to choose the site of your home,* locate it on porous 
soil ; if not, see that the drainage is perfect. 

11. Protect all raw or wounded surfaces from any possible tubercu- 
lous infection. 

12. Do not forget that every case of consumption comes from a 
precedmg one. 

The question of tubercular people marrying, the proper care of 
women during and after pregnancy, the prohibition of tuberculous 
mothers nursing their children, and careful attention to the nutrition 
and development of such children, are of vital importance. That the 
time is ripe for the State to take cumpulsory measures in stamping out 
tuberculosis in cattle is unquestionable; it should have absolute con- 
trol and supervision, making it compulsory that all commercial dairies 
should be examined periodically. The strict and complete separation 
of sound from unsound animals; the unsound should be disposed of 
as expeditiously as possible. The farmer should have a just compen- 
sation based on the value of the animal at the time of examination. 
There should be a more liberal appropriation; $7,000 is a small 
amount to carry on this work successfully. The competent inspection 
of all stables in order to insure adequate ventilation, cleanliness, and 
to prevent overcrowding, would be a great help to clearing the herds 
of tuberculosis. The State should not allow the indiscriminate impor- 
tation of cattle from other States without some guarantee as to the 
condition of their health ; this would stop one prolific source of infec- 
tion. 



98 MEDICAL SOCIETY OF NEW JERSEY. 

It appears that while the proof of the transmissibility from man to 
the cow is readily obtained by experiment, that the transmission in the 
opposite direction cannot be made experimentally. Sufficient clinical 
evidence, however, has been accumulated to place this matter beyond 
a reasonable doubt, and the stamping out of bovine tuberculosis would 
doubtless be followed by a marked decrease in the death rate from 
tubercular phthisis. 

While the complete stamping out of bovine tuberculosis must at 
present be regarded as Utopian, still the inspection of dairy herds and 
their products is within the power of any Board of Health that will 
spend the time and money to do it. Every cow furnishing milk that 
is offered for sale should be subjected to the tuberculin test ; and the 
inspection of milk should be not only for fat and total solids, but also 
for the presence of the tubercle bacilli. There are fashions in medi- 
cines as in all else, and th^re seems to be a growing tendency in cer- 
tain quarters to decry the frequency of the transmission of this disease 
to man through food products. To this we may answer that the germ 
supports a saprophytic existence with difficulty, and there is no doubt 
that the cow is less readily affected than man, as her temperature is 
above the optimum of temperature of the bacillus, while 98.5° F., the 
temperature of man, is about that of the optimum of the germ ; and 
it is well to bear in mind in all inoculation experiments or in the 
attempted transmission of the disease from man to the cow in food 
products, that the percentage of failures from man to the cow will be 
greater than if the experiments were made in the reverse direction. 

In this State we have to deal with a peculiar condition of affairs in 
our efforts to stamp out this disease. Instead of the matter being 
under the control of the State Board of Health it is distributed between 
the Tuberculosis Commission and the Dairy Commission, both of them 
without a scientific head and working independently. To illustrate, 
if we have to deal with a dairy where tuberculosis is suspected, the 
matter is dealt with by the Tuberculosis Commission. If the milk is 
not all it should be in fat and total solids, by the State Dairy Com- 
mission. If the sanitary condition of the stable is not good, by the 
State Board of Health. While I believe the State Tuberculosis Com- 
mission is doing a good work, I think it is questionable whether it 
would not be better to bring the entire control of these matters where 
it belongs, in the State Board of Health. 

To what must we further look in a careful consideration of our 



APPENDIX TO THE MINUTES. * 99 

duties to these unfortunates. There seems to be one idea which pre- 
dominates all others — the erection of special institutions for their 
treatment, under the care of men thoroughly equipped for the work. 
Modern phthisio-therapeutics as carried out in well regulated sanitaria 
must be practically studied. The establishment of a medical training 
sanitorium, with a course of four or five months, during which time 
each physician would have a certain number of patients in his care, 
all under the watchful eye of a man who has proved by his results 
that he was capable of carrying such a work to a successful issue. 
Nurses should be physically strong, and have a special training for 
this work. At the Loomis Sanitarium they have a training school, 
which is doing a good work in preparing women for the special duties 
required in nursing tuberculosis patients. 

Throughout the civilized world there is a movement in favor of such 
institutions. Hardly a month passes which does not see the develop- 
ment of a sanitorium in Germany. As to the location of such an in- 
stitution, a place of a fair altitude, well exposed to the sun, with pure 
air, is largely what is needed. I believe it is a matter of vital import- 
ance that a consumptive be cured in the climate in which he will re- 
side. One point was forcibly demonstrated by the Berlin Conference, 
that the sanitorium treatment is the only treatment which is likely to 
bt at all successful, and that cures are altogether independent of cli-- 
mate. Most of us are convinced of the almost uselessness of the 
treatment of such cases at ordinary hospitals and infirmaries. Dr. 
Petit pictures this very accurately : *' Hospitals as they are presently 
organized cannot open their doors to the consumptive as long as he 
can walk." The fundamental elements for the treatment of consump- 
tion are not at present to be found in our hospitals, which are organ- 
ized for quite another purpose. His cure is a hopeless problem in a 
hospital where he is lost in the crowd of other patients, and to which 
he is only admitted out of pity, when the disease arrived at its last 
stage offers no scope for treatment. Will he find here the combined 
conditions necessary for the treatment of his disease ? Will pure air 
a constant renewal of which is so essential to him, be provided in suf- 
ficient quantity.^ Will antiseptic precaution be taken especially for 
him ? Then, the food — the most important factor in the treatment, 
Will it be provided for him in the abundance which is indispensable, 
and dainty enough to tempt his appetite and build up his strength ? 
I am convinced that the erection of sanitaria will do more to control 



lOO MEDICAL SOCIETY OF NEW JERSEY. 

the spread and reduce the mortality of phthisis than anything else. 
The medical and sanitary advantages of erecting sanitaria for con- 
sumptives would be many ; the educational effect of sanitaria upon 
individuals as well as communities is marked. In Germany, at Goer- 
bersdorf and Falkensteen, the two largest sanitaria, the mortality from 
phthisis has shown a marked decrease ; a decline of at least one-third 
since the establishment of these institutions. This may be due to the 
example set by the patients, and demonstrates that such institutions are 
not centres of infection. The per diem expenses of a well-organized 
sanitarium for consumptives is about the same as a general hospital, 
ranging in cost from $1.43 to 40 cents. The results obtained in 
sanitaria are excellent. Most of the statistics show cures of about 30 
per cent, amelioration 35 per cent., and the Loomis Sanitarium as high 
as 70 per cent, in early cases ; competent authorities say these figures 
are correct. In looking at this question from an economic standpoint, 
Knopf's statistics are interesting ; he says the total time a consumptive 
spends in the hospitals is about fifteen months. As the expense per 
capita in New York hospitals daily is $1.16, we can readily see that 
the cost to the city has been $522, not taking into consideration the 
amount expended on the family. If the patient had been sent early 
to some well equipped sanitarium his chances of recovery would have 
increased 50 per cent., and the cost of maintenance about one dollar 
a day for about six months. Thus the 2.000 tuberculous patients 
treated in the general hospitals in New York with very little chance of 
being cured, cost the city $1,044,000. Treated in sanitaria, $890,000, 
a clear gain of $150,000, saving hundreds of lives, eradicating centres 
of infection, which would be a menace to their families and friends, 
not taking into consideration the restoration of the bread winner. 
Bearing in mind the time of life persons are most liable 10 contract 
tuberculosis, /, <?., puberty to thirty, it is readily seen that the subjects 
are attacked during the most useful period of their existence. The 
crowned heads of Europe are taking a practical interest in such insti- 
tutions, many are under their protection, and they provide liberally for 
their support ; people in all walks of life are following this excellent 
example. In this field there is a grand opening for financiers to com- 
bine business and charity. Several years ago a few wealthy citizens 
of Frankfort-on-the-Main opened a sanitarium for people of means ; 
they pledged themselves not to accept more than 5 per cent, on the 
invested capital, the surplus to go towards the erection of a sanitarium 



APPENDIX TO THE MINUTES. lOI 

for the poor. As a result there is to-day a Ruppertshain, a flourishing 
institute for the poor. Here is an excellent field for philanthropists to 
aid the State in helping these unfortunates, and preventing the spread 
of this dire affliction. The State must build sanitaria, or convert suit- 
able buildings in good locations into temporary sanitaria, in which the 
good work may be carried on. It is the poor who need our help the 
most. Slowly we would become master of the disease, and would soon 
find that the cases admitted to the sanitarium were incipient ones» 
practically insuring their being cured. This would largely decrease 
the fresh cases as the sources of infection because less numerous, and 
as each patient, an apostle for a more rational mode of living, spreads 
his training among his fellows, the time would be short when this ter- 
rible malady would not be dreaded, if not entirely eradicated. The 
systematic dissemination by circulars of the plan adopted by the Penn- 
sylvania Society for the Prevention of Tuberculosis, will do much for 
prophylaxis and the proper education of the masses to prevent infec- 
tion. Dr. Flick, of Philadelphia, the president of this society, who has 
devoted so much time to the careful study, and the means to be em- 
ployed in exterminating this disease, will, when the history of the 
extermination of tuberculosis shall have been written, stand out as a 
bright and shining light in the galaxy of noble men who have devoted 
their life-work to this cause. If we are sincere in our desire to fight 
tuberculosis to the point of eradication, besides the enforcement of 
stringent laws against bovine tuberculosis, complete hygienic, prophy- 
lactic regulations, and public education, we must insist upon the State 
taking upon itself the care of incipient and advanced cases of tuber- 
culosis, not only among the poor, but with those of limited resources. 
The State of New Jersey recently assuming the care of epileptics, can 
readily be shown manifold reasons for taking upon itself the care of 
consumptives. 

Can we not, as a society, take up this fight, appoint a committee 
with full power to study this question, draft a proper measure and 
work untiringly for its passage by the Legislature. New Jersey is 
well able to do this from a financial standpoint, regardless of our 
great duty to suffering humanity. The erection of such institutions 
is not a fleeting fancy, it has come to stay ; and New Jersey, progress- 
ive in many ways, should ever be to the front in this fight against 
tuberculosis. As a still further aid to this work, a commission should 
be appointed, composed of general practitioners and health oflicers. 



I02 MEDICAL SOCIETY OF NEW JERSEY. 

to investigate all cases on these lines : First, determine the applicant s 
condition by a medical examination. Second, to visit his home, if he 
has been found tuberculous, institute such hygienic measures as seem 
necessary. Third, examine other members of the family and see if 
they have contracted the disease, and if so, institute proper treatment. 
Fourth, report in full to the sanitary authorities concerning the condi- 
tion of the patient's dwelling. Fifth, to determine the financial con- 
dition, whether the patient is or is not able to pay, and whether or 
not, by his being taken to an institution, the family will become desti- 
tute. Sixth, any individual should have the right and every physician 
be at liberty to present persons for examination to the board. 

The institutions needed to carry out this plan would be a centrally 
located dispensary or reception hospital. The dispensaries could 
treat the ambulant patients and would serve as a place for patients 
discharged from sanitaria to seek counsel so as to guard against 
approaching relapses. One or more sanitaria situated within a few 
hours* ride of the cities, at a fair altitude, on porous ground, with 
southern exposure, for the systematic treatment of incipient and ad- 
vanced cases. 

Consumption is unquestionably a social disease, and society must 
do its share with the medical men to eradicate it among the wealthy 
as well as the poor, it will require the combined efforts of physicians, 
statesmen, philanthropists and boards of health to accomplish this 
end. May we not hope that with such united effort before the first 
decade of the new century is finished the tuberculosis problem may be 
solved, when it is hoped we may be able to control infection and this 
most deadly foe of man, the great white plague, be banished from 
the earth. 

BIOLIOGRAPHY. 

Flick's articles on the contagiousness of tuberculosis. 

Flick's prophylaxis and treatment. 

Flick's mode of entrance of bacillus. 

Osier's article of tuberculosis. 

Knopf's treatment and prevention of tuberculosis. 

Loomis Sanitorium reports. 

Reports of Woldeck's Sanitorium. 

Reports of Noordach's Sanitorium. 

Sinclair's treatment of tuberculosis. 



APPENDIX TO THE MINUTES. 103 

Reilley's treatment of the tubercular. 
Trudeau reports Saranac Lake Sanitorium. 
Trudeau articles of prophylaxis and treatment. 
Falkensteen Sanitorium reports. 
N. S. Davis' prophylaxis in tuberculosis. 
Infection tubercular (E. R. Baldwin). 
Bermingham on treatment of the tubercular. 
McFarland on Tuberculosis and Tuberculin. 



i04 medical society of new jersey. 

•Progress in Medicine. 

BY D. BENJAMIN, M. D. 

To give the progress Of medical science throughout the world, the 
real and actual progress accomplished, the genuine improvements and 
discoveries made, so as to bring the subject up to date for the benefit 
of those who wish to avail themselves of the advance and advantages, 
in a fifteen minute paper, is looked upon in two ways ; by one set of 
men it is regarded as an impossible task even in the space of an hour, 
only undertaken by a monumental fool or consciousless egotist ; my 
learned friend, Dr. Gould takes 583 royal octavo pages to do it. 
While another set of men, equally earnest and emphatic, will claim, 
if carefully collected and sifted, one page of five minutes time will be 
ample to contain it all. Since I am given by our rules fifteen minutes 
and intend to use them all, I suppose I will be put in the class known 
as the *' middle of the road," on this problem. 

I thank the Society for the honor conferr^ in trusting me with the 
preparation of such an important paper. 

TPPHOID FEVER. 

Wtdars Test >yas carried out in 4,154 cases in the laboratories of 
the Board of Health of Philadelphia and the error had been but 2.8 
per cent., according to Dr. A. C. Abbott. The test seems to have 
great reliability. 

It has been found that the rose spots of typhoid fever contain the 
bacilli, demonstrable by the ordinary tests. It has also been found 
that the urine is usually loaded with the bacilli in this disease. 

Considerable effort has been made of late to ascertain the true value 
of certain methods of treatment which have been put forth within the 
last few years as possessing great merit. One of the most important 
and reliable contributions in America on the Currie-Brand or cold 
bath treatment was a paper by Dr. J. C. Wilson read before the Cam- 
den County Medical Society in February last. He clearly showed 
that in the hospital under his care (the German) the death-rate in 7,ocx> 
cases (quite a sufficient number) was only 7 per cent., while the death- 
rate of the entire city, according to the city official returns from all 
sources, was 14 per cent, in 33,000 cases. While this report is very 
valuable in showing the death-rate under the Brand treatment, to be 
of any real value as showing the results compared to other treatments 
under practically the same conditions, his comparison should have 



APPENDIX TO THE MINUTES. I05 

been made with the results obtained in other hospitals in Philadelphia, 
for the same period of years, and not exclusively with the municipal 
returns where there was often no treatment or worse than no treat- 
ment given the case. 

I can give the results of the treatment in Cooper Hospital, Cam- 
den, N. J., without the Brand method. 

YEAR. CASES. DEATHS. MORTALITY. 

1890 23 3 14^ 

1891 45 I 25^ 

1892 30 I yf> 

1893 37 I 2^ 

1894 35 2 5^ 

1895 57 3 5^ 

1896 46 3 65^ 

1897 42 5 10^ 

1898 43 2 4^ 

1899 37 o o^ 

395 21 5.32^ 

The careful investigation and valuable figures of Dr. E. Winters, 
of Bellevue Hospital, New York City, are, I think, worthy of great 
confidence. 

After years of investigation, he gave the mortality under the Wood- 
bridge treatment as ^,^^ in 78 cases carefully observed, and these 
were less apt to become complicated than the cases treated by the 
Brand method. — 20th Century Practice, vol. xvi. 

The Woodbridge treatment gives about as good results as any. 
Personally, I use a modified Woodbridge treatment. It is almost 
impossible to use the Brand treatment in private practice, as you 
know, and letting the patient get out of bed and walk to the bath- 
room to take a cold bath, as advised by Dr. J. C. Wilson, is claimed 
to be '• indefensible." 

DIPHTHERIA. 

The statistics compiled in the Department of Health, February, 
1899, of the city of Chicago, gives 4.071 cases of diphtheria treated 
with anti-toxin. I do not know what other treatment they received, 
but presume, they, at least, receive some local treatment other than 
anti-toxin, with 276 deaths, or a mortality of 6.775^ ; these statistics 
extended over a period of three years. It is claimed that, previously 



I06 MEDICAL SOCIETY OF NEW JERSEY. 

to this, the mortality was 50^ in Chicago. I hope none of you, gentle- 
men, had such an experience. I feel bound to say that I believe care- 
ful personal investigation as to the manner of making their statistics 
(6.77^ and 50^) would greatly alter them both. 

The mortality of the Municipal Diphtheria Hospital, of Philadelphia, 
and the treatment employed is concisely set forth in the following 
letter in answer to my inquiries, from Dr. Wm. M. Welch, the dis- 
tinguished and able physician in charge. 

" Phila., May 17th. 1900. 
" Dr. D. Benjamin : 

•• Dear Doctor:— Since I commenced using anti-toxin, the death- 
rate from diphtheria in the anti-toxin cases has been each year, as 
follows: 1895,28.11^; 1896,25^; 1897,26.28^: 1898,25.23^; 1899, 
20^. 

" Internally, I use iron (tinct.), quinine, strychnine, digitalis, nitro- 
glycerine, alcohol and various other drugs, according to indications. 

" Externally, peroxide hydrogen, as .routine treatment, normal salt 
solution in nares. Sometimes we use Loeflfler's solution to the fauces. 

•* Yours very truly. 

•« W. M. Welch." 

"May 19. 1900. 
" Dear Dr. Benjamin : 

** The mortality at the Willard Parker Hospital in 1896 was 25.9 per 
cent.; in 1897, 24.3 per cent. ; in 1898. 17.1-2 per cent.; in 1899, 24.4 
per cent. The first four months af 1900, 25 per cent, plus — 

" What is of more importance than the general mortality is the fact 
that the mortality in children under five years of age is from 35 to 36 
per cent. The mortality in intubation cases for the period of six months 
has been as high as 82.8 per cent. In July, last year, of ten intubation 
cases nine died ; in December, thirteen intubation cases, eleven died* 
All of these cases were treated with antitoxin. 

" Very sincerely yours, 

"J. E. Winters," 

A few years ago Professor Loeffler treated seventy-one consecutive 
cases of diphtheria in a severe epidemic and cured them all by simply 
sterilizing the air passages with an antiseptic solution. During the 
past twenty years I have used the same kind of practice, that is, steril- 
izing the air passages with an antiseptic solution, but it is more 
pleasant than LoefRer's, and giving at the same time internally, tind. 



APPENDIX TO THE MINUTES. 107 

ferri chloridi in large and frequent doses. I have had over a hundred 
cases without a death, except one, which on account of doubtful diag- 
nosis should not be included. Dr. Kelchner, a former student of mine, 
estimates that he has had about seventy-five cases on the same treat- 
ment without a death. 

DEATHS. 

Loeffler 71 consecutive cases. o 

D. Benjamin 100 " " o 

Kelchner 75 " " o 



246 o 

None of these received antitoxin. 

Two cases died before treatment could be applied, as they were 
moribund when we were sent for, one in the practice of Dr. Kelchner 
and one in my own consultation practice. 

I do not believe the death-rate in diphtheria in the United States in 
private practice, prior to the year 1894, averaged over 25 per cent. I 
doubt if any of you gentlemen in a large series have lost more. I have 
examined altogether the statistics of over 40,000 cases. In 1859 the 
British Medical Journal gave the mortality in diphtheria as 14.2-7 per 
cent, in a severe epidemic. The death-rate is now running 23 per 
cent, in Philadelphia, according to the municipal returns of over 3,000 
cases furnished me. 

STATISTICS, 

The study of the value of treatment in any disease by means of 
statistics seems essential, but statistics, as they are furnished, are so 
uncertain and difficult to understand, unless an expert at the business 
makes an investig^ation, that few reliable conclusions can be drawn 
For instance, I once investigated the report of the Camden County 
Insane Asylum, which claimed officially 70 per cent, of cures, and I 
found it to be less than 10 per cent., and published the fact in the 
county; my report was not challenged but the management was 
changed. 

No subject is so important at present, and none so much in need of 
reform. We rail at politicians because they permit a contaminated 
water supply sometimes, and at the same time we take no adequate 
means ourselves to insure accuracy in the very foundation data, of 
medical science. I would suggest for the benefit of medical science, 
that the State or National Society employ shrewd and careful experts 



I08 MEDICAL SOCIETY OF NEW JERSEY. 

to devote their whole time in verifying statistics in detail, by visiting 
the locations, making personal investigations and reporting to a coun- 
cil or committee of the Society. 

FINSEN'S PHOTO-THERAPY. 

One of the important and interesting advances of the year has been 
the development of this subject (Dr. Vaddimar Bie, Philadelphia Med- 
ical Journal, October 7, 1899). Absolute and satisfactory results 
have been obtained in some important microbic diseases, for instance, 
lupus ; but I will have to refer you to the original paper for details. 

X-RAY. 

In addition to enabling us to see disease of the internal organs, it 
has been found to cure some skin diseases, notably eczemas. 

CONSUMPTION. 

Birch-Hirshfield and others have made extensive investigations 
which tend to prove that consumption is hardly ever inherited, but 
that the susceptibility, or more correctly speaking the histological — 
inherited — construction of the tissues, favors the development of the 
disease, provided the bacilli are introduced ; and that pulmonary con- 
sumption is nearly always due to the inhalation of the bacilli of 
tuberculosis. 

PNEUMONIA. 

The ic€ treatment. Nothing has startled the laity more than treat- 
ing pneumonia by packing the patient's chest in ice. A community 
that for years has been taught by the profession to avoid taking cold 
as you would the plague, and had been using cotton jackets and hot 
poultices, is apt to stand aghast when they see the ice treatment ap- 
plied. The results, however, have not been so bad. The veratrum 
viride treatment, however, has not been surpassed. 

Theoretically serum therapy should be specific, but the data so far 
requires close examination and is not conclusive. 

ERYSIPELAS, 

or streptococcus poisoning, has been successfully treated with anti- 
streptococci serum, streptococcus antitoxin; 413 cases (reported by 
Jackson) give a mortality of 3.87 per cent, in erysipelas. He claims 
under other treatment to be 5 to 1 2 per cent. 



APPENDIX TO THE MINUTES. IO9 

Benome and Viola have demonstrated that the most virulent cultures 
of streptococcus are rendered harmless by faradic current of electricity, 
and that the toxins of the streptococcus are transformed under the 
influence of electrical currents into antitoxins ; that these antitoxins 
obtained by electricity from old cultures are very active. It is possible 
to neutralize in the system streptococcus cultures of tenfold the death 
dose for rabbits, and these antitoxins possess a strong protective and 
curative property against streptococcus infection. 

I am unable to say whether this antitoxin will be found equal to 
that of Marmorek, as it has not, like the latter, been sufficiently used 
in. human subjects, but seems to be a very important discovery. 

Progress in State Medicine. 

BY HENRY MITCHELL, M.D., ASBURY PARK, 

Among the duties prescribed by the By-Laws is the annual pre- 
sentation of records showing the advance made in six of the most 
important departments of the art to which the lives and labors of the 
members of the Medical Society of New Jersey are devoted, and I 
have been invited to bring to your attention on this occasion some of 
the current views and opinions concerning the maintenance of health 
and the prevention of disease, and to briefly review some of the 
events of the year within the domain of public hygiene. Limitations 
of time and prudence will admit of but general reference to a few of 
the questions related to this broad subject. 

l^egislation in New Jersey for the protection of the public health 
has received additions during the past year, as follows : 

1. Chapter 4 of the laws of 1900 provides that in cases where local 
boards of health fail to enforce the law requiring returns of births, 
marriages and deaths, the State Board may bring suit for the penalty. 

2. Chapter 69 provides for an entire change in the system of 
maritime quarantine. 

3. Chapter 132 authorizes the city of Newark to establish an isola- 
tion hospital. 

4. Chapter 1 56 specifies the manner in which the transportation of 
dead human bodies shall hereafter be conducted. 

Section 255 of Chapter 96 (the general school law) authorizing 
boards of education to secure medical examination of pupils, has 
already been taken advantage of in a few districts, and the arguments 
for the introduction of this means of preventing illness among school 
children, which have been forcibly presented by the members of this 



no 



MEDICAL SOCIETY OF NEW JERSEY. 



Society during the past few years, have now been replaced by an 
active interest in the details of the methods to be employed whereby 
the best results attainable under the law may be realized. 

Assuming that the persons appointed to perform the service of 
medical inspection will be busy practitioners, it becomes necessary to 
so arrange the duties that they will not conflict with private profes- 
sional business, for the compensation for the time devoted to this 
service will be small, certainly, at the beginning of the work. It is 
desirable that the daily morning visit to the school building should be 
very brief and that this visit should be only intended to enable the 
physician to diagnose any cases of illness which may have appeared 
among the pupils at the beginning of the morning session, and the 
regular visit need consume no more time than an ordinary visit in 
private practice. 

Upon entrance into the school building the medical officer should 
find in his box a card for each pupil who is considered by any teacher 
to be ill, and some prearranged signal should at once bring the child 
who is believed to be sick to the doctor's desk. 

PUBLIC SCHOOLS. 

DEPARTMENT OF MEDICAL INSPECTION. 



o 

to 

a 



:3 
Si 

"o 
o 

M 



> 






B o 



Date 



Name of pupil 

Residence 

Age Class 

Any cases of sickness at home ? . . 



Symptoms noted by teacher 



Teacher. 



M 



Card to be filled out by the teacher. 



w 



2cr 
rr rt 

en O 

ETC 
O '* 

^^ 
n <» 

3* JO 
n n 

::^ 

u> — 



APPENDIX TO THE MINUTES. 1 I I 

The diagnosis having been completed, the physician endorses the 
card sent by the teacher, places it on file and disposes of the case by 
returning the child to school duties or by sending him to his home with 
advice to the guardian to place the child under the care of the family 
physician. In this manner the labor of the morning visit is reduced to 
a minimum. A conveniently arranged card-index cabinet will prove 
for the physician a time-saving means of recording each case, and a 
suitably printed card will furnish a ready means of communicating 
with the parent or guardian. 

This daily routine carried through the school year, will, by the aid 
of alert and discreet teachers, detect and exclude every case of acute 
illness before the disease has made serious progress, except measles, 
and the value of this portion of the service will soon commend itself 
to every parent To the teacher it will prove a source of great rehef, 
for the responsibility hitherto borne in deciding when to exclude pupils 
because of illness has been a trying and unsatisfactory duty. In case 
diphtheria is discovered, frequent examinations of the throats of all 
of the persons in the room occupied by the patient should be made, 
and the aid of the State bacteriological laboratory should be employed 
to assist in detecting the presence of the disease. 

The purification of infected apartments in school buildings 
should not be undertaken by the medical officer nor by the teacher, 
janitor or board of education, but should be performed by or 
under the supervision of the proper officer of the local board of 
health, and all responsibility for complete and thorough disinfec- 
tion of school premises, as well as the houses of infected pupils, 
should be borne by the health board. The janitor should, 
however, be instructed in the disinfection of pencils, books and 
other utensils, and these articles should be subjected daily, during 
he prevalence of diphtheria and scarlet fever, to cleansing and dis- 
infection. The janitor should also be taught the germicidal value of 
cleanliness, and each afternoon the school rooms, especially desks, 
door-knobs, hand-rails and all other surfaces liable to be touched by 
the hands of the pupils, should be made as clean, by the use of soap 
and water, as any private house in the district. 

Wholly aside from the daily morning visits above referred to, an- 
other and altogether independent service is to be rendered by the 
medical inspector of schools. Once in each year a careful and de- 
tailed examination of every pupil is to be made, and a blank record 



112 MEDICAL SOCIETY OF NEW JERSEY. 

card should be filled out, upon which is shown the age, the weight, 
the height and a statement relating to any abnormal conditions of 
the eyes, the ears, the spine, the throat and the lungs, and also any 
abnormal conditions of development or nutrition. This examination 
can, of course, be conducted by the physician at his convenience, 
preferably in the afternoons, and the number of pupils to be examined 
at each sitting can be determined only after experience in the case of 
each inspector. 

PUBLIC SCHOOLS. 

DEPARTMENT OF MEDICAL INSPECTION. 

No Date Class 

Name ... Age 



Weight Height General condition 

Chest measurement : Inspiration : Expiration. 

Dorsal spine 

Cutaneous diseases 

Heart Lungs 

Throat 

Naso-pharynx 

Nasal septum Teeth . . 

R 



Eyes . ^^ 



1^. 



Ears 

Date of last successful vaccination. 



Permanent record card. 

The card-index system will afford the most satisfactory method of 
making these permanent records, and the facts recorded will, in this 
form, be always available for ready reference. 

New Jersey is the first State in the Union to extend by law to every 
school district, authority to employ medical skill in the daily 
supervision of the health of the pupils, and the experience already 
accumulated in the few cities and larger towns in this and other States 



APPENDIX TO THE MINUTES. II 3 

in which the system has already been employed, fully justifies the 
expectation that this innovation will soon take rank as one of the 
most useful and welcome of the co-operative devices for the general 
welfare of organized communities. 

The opposition of parents who are so unreasonable as to be offended 
because of the exclusion of their children from schools during the 
period of infection will, of course, be encountered, but with the pro- 
gress of the work the benefits to the greater number will outweigh 
the objections and selfish protests of the objectors and there will al- 
ways be a large majority of citizens in every community who will 
support the medical officer and the board of education in protecting 
the children from dangers to health. Doubtless every member of our 
profession will look with much interest upon the preliminary opera- 
tion of this provision of the new school law, and all will find pleasure 
in the final adoption of perfected methods for carrying on the work in 
the most efficient manner possible. 

The investigations into the spread of malarial affections through the 
agency of mosquitoes, which has been actively pursued during the past 
year, has strengthened and confirmed the evidence showing that the 
Plasmodium malariae is readily conveyed by suctorial insects from an 
infected individual to a healthy one.* The anopheles do not breed 
except in stagnant pools of water on the ground, and they become 
infected only by ingesting blood from an animal which is carrying the 
germs. It has been shown that the malarial parasites do not them- 
selves rise from the soil and that they are not carried by mists. 
Draining of ditches and breeding pools is therefore an effectual pre- 
ventive measure against malaria, and the view which has long pre- 
vailed that this disease is conveyable by aerial influences must be 
abandoned. In cases where the surface of the soil cannot be dried 
by drainage, the larvae can be destroyed, when such a procedure is 
practicable, by floating petroleum upon the surface of the water, thus 
preventing admission of air to the undeveloped insect. Quinine kills 
the parasite within the human body, and is removed as a remedy by 
these investigations from the empirical group and firmly placed in the 
rational class of germicides. 

The crusade against tuberculosis has continued with increasing 
energy, and new forces have joined in the fight. The popularization 
of knowledge concerning the infectiousness of phthisis has been 

"^Lancet, February 3, 1900, page 323. 
8 



114 MEDICAL SOCIETY OF NEW JERSEY. 

extended and few infected persons are ignorant of the modes by 
which this affection is communicated. Researches of Bruce-Hirsch- 
field" and others show that the bacillus of tuberculosis has a very 
feeble vitality and a weak infectivity, and that the parasite can only 
with difficulty become installed in its human host ; that dry air and 
sunlight will kill the microbes in a few hours ; that the virulency of 
the bacillus and the susceptibility of the individual are governing 
factors in the establishment of this disease. It has been conclusively 
shown that environment and the conditions of the general health of 
human beings are influences which control and, to a large extent, 
limit immunity, and that the attack-rate in crowded, dark, illy ven- 
tilated dwellings is much greater than, other things being equal, in 
houses of better construction. 

Notification of cases of phthisis and purification and improvement 
of infected apartments and premises seems, therefore, to be an essen- 
tial step in preventing the spread of this disease. The immunity of 
nurses and relatives who live and often sleep with phthisical patients 
demonstrates the existence of the personal factor in the resistence 
offered to the implantation of the germ. These observers report that 
out of four thousand consecutive necropsies made of persons of all 
ages, dying from all manner of complaints, forty per cent, were shown 
to be suffering from tuberculosis of the lungs which had become 
encapsuled and had given, in most cases, no evidence of invasion 
during life. It is estimated that cases in the incipient stage probably 
reach as high as eighty or ninety per cent, of the total population, 
but when the disease advances to a point where physical signs are 
apparent before treatment is adopted, the proportion of cases is 
lowered to 50 per cent. Efforts rendering the community less vulner- 
able should be directed toward cleanliness of the home and of the 
person, out-of-door exercise, sunlight and wholesome food and water. 

The proposal to provide State sanitoria for the reception and treat- 
ment of consumptives has met with general approval among physi- 
cians and has already been in successful operation in Massachusetts. 
Under a recent enactment. New York State is about to establish an 
institution in the Adirondack region for the reception and care of this 
class of patients. Positive evidence has continued to accumulate 
showing the danger from the use of milk' derived from tuberculous 



^Lancet, August 19. 1899, page 499. 

'Journal American Medical Association, October 14, 1899, page 988. 



APPENDIX TO THE MINUTES. 1 1 S 

cows, tubercle bacilli having been found not only in such milk but 
also in the butter and cheese prepared therefrom. 

The fact that bubonic plague has obtained a foothold in South 
America and that it has prevailed to a serious extent in Hawaii, and 
more especially because the disease has been brought as near to New 
York City as the quarantine station of the port, and because cases- 
have appeared in San Francisco, has given rise to a greater 
degree of interest in this affection than sanitary officers in the United 
States have hitherto had reason to experience, and the question of 
danger from the importation and spread of this pestilential disease is 
before us. Tht Lancet in a recent issue, says: '* The plague has now 
existed in India for five years, has destroyed over 250,000 lives, and 
shows not the slightest tendency to abate its fury, the present rate of 
mortality being nearly five thousand inhabitants every week. Plague 
is the same as it has always been, and the only safe course is not to 
shut our eyes to its power and to our proved inefficiency for defence, 
but to prepare beforehand for eventualities." 

In a recent address, Dr. George W. Sternberg, Surgeon-General 
U. S. A., says : '* We have learned that certain of the lower animals, 
including rats and mice, are very susceptible to infection and that they 
play an important part in the propagation of the disease ; also, that 
the germs are found not only in the blood and in pus from suppurating 
buboes, but also in the discharges from the bowels of infected indi- 
viduals. This being the case, it can readily be seen how important a 
strict sanitary police is in arresting the spread of an epidemic. As 
in other filth diseases in which the germ is present in the excreta of 
the sick, insects, and especially fleas and house flies, play an import- 
ant part in the spread of the disease." 

Biological purification of sewage which consists simply in employ- 
ing, under control, the same agencies which have always been used by 
nature in breaking up organic materials and restoring the elements to 
conditions favoring new combinations, has become more firmly estab- 
lished as a recognized principle in the treatment of waste fluids.* As 
a means of partial purification of crude sewage, coke filters have 
been experimentally introduced in London with satisfactory results, 
fifty per cent, of the putrescible matter being removed, as compared 
with seventeen per cent, by chemical treatment, while the resulting 
effluent is free from odor and does not become foul when it is kept. 

^Sanitary Record, October 27, 1899, p. 371. ^Lancet, October 14, 1899, p. 1034. 



Il6 MEDICAL SOCIETY OF NEW JERSEY. 

The process is dependent essentially upon aeration, and its useful- 
ness is conditioned upon its being intermittently applied. This pro- 
cess, in view of its efficiency and economy, appears to be well adapted 
to the needs of seaside towns where the purification is not required to 
be carried to the same degree that is necessary when the effluent is to 
be discharged into the waters of streams used for potable purposes. 

Commercial influences have been exceedingly active durirtg the past 
year in endeavoring to create arguments to justify the practice of 
adding antiseptics to foods — especially to milk, and numerous investi- 
gations have been conducted to definitely establish the true relation 
which the addition of such substances has to the health of consumers. 
It has been a contest between the financial interests of producers, 
manufacturers and dealers on one hand and a scientific search for 
facts on the other hand. The accepted results of these inquiries 
warrant prohibition of the addition of preservatives, in any quantity 
whatever, to milk. The evidence is overwhelming and shows that 
the substances employed — borax, boracic acid and formaldehyde — 
lessen the digestibility of milk, and in large quantity produce a toxic 
effect.* The dealer is extremely tenacious in his desire to be per- 
mitted to use these articles, because he is able to sell old milk for 
new and because he is relieved of the annoyance and expense conse- 
quent upon the use of ice. 

A little more light has been thrown upon some of the avenues 
through which the bacillus of typhoid fever is conveyed to the ali- 
mentary canal of human beings, and it seems worthy of note that an 
outbreak of this disease in the insane asylum at Northampton. iMass., 
was clearly traced to the eating of celery. The investigation showed 
that the sewage of the institution was spread upon the celery beds 
and that the typhoid bacillus was transmitted upon the unwashed 
stalks of the plant, forty of the inmates being affected with the dis- 
ease within two weeks. 

The danger of the spread of typhoid fever by the use of natural 
ice obtained from polluted waters, has long been recognized, but 
manufactured ice has been regarded as altogether free from bacteria 
because of the process of distillation to which the water from which 
the ice is made is subjected, but recent inspections of the details of 
the process show that in some instances the distilled water is filtered 
through sponges to remove the oil which unavoidably gains access to 

f Lancet, Decembwr 9, 1899, page 1582. 



APPENDIX TO THE MINUTES. 11/ 

the storage tanks and which floats as a film upon the surface. These 
sponges are handled daily by the employees and no attempt is made 
to guard them against contamination nor to purify them. 

I must content myself to let these brief references to recent observ- 
ations and demonstrations in hygiene serve as an indication of the 
substantial progress made during the past year in applying this art to 
the uses of mankind, and we may confidently anticipate future con- 
quests of nature's mysteries surrounding the causes of disease and 
the modes of its dissemination, which will ever extend and enlarge the 
responsibilities and opportunities of the physician in his private rela- 
tion to his patient, as well as in his public duty in the prevention of 
disease and promotion of health. 



Report of the Committee on Medical Inspection 

OF Schools. 

The Committee are pleased to report that, since the last meeting of 
the Society, the Legislature of the State of New Jersey have adopted 
an act to establish a system of public instruction (revision of 1900). 
This act was framed by a special committee, of which Senator Stokes 
was chairman. The committee undertook to revise, compile and 
place in one act all of the laws of the State relating to educational 
matters, making such additions and alterations as might be necessary 
to make the law comprehensive, effective and thoroughly up to date. 
The Committee of the New Jersey State Medical Society upon the 
Medical Inspection of Schools placed in the hands of this committee 
on revision of the law, a copy of the 1899 committee report, with the 
special request that the recommendation of the committee might be 
considered in the revision of the law. 

The follovying extracts from the bill as passed and approved March 
23, 1900, are all that relate to the appointment of medical inspectors, 
or the prevention of communicable eye disease : 

Article XXX.— Section 255. 

appointment of medical inspector ; DUTIES. 

Every board of education may employ a competent physician to be 
known as the Medical Inspector, fix his salary and define his duties^ 
Said Medical Inspector shall visit the schools in the district in which 



Il8 MEDICAL SOCIETY OF NEW JERSEY. 

he shall be employed, at stated times, to be determined by the board 
of education, and during such visits shall examine every pupil referred 
to him by a teacher. He shall, at least, once during each school year, 
examine every pupil to learn whether any physicial defect exists, and 
keep a record, from year to year, of the growth and development of 
such pupil, which record shall be the property of the board of educa- 
tion, and shall be delivered by said Medical Inspector to his successor 
in office. Said Inspector shall lecture before the teachers at such 
times as may be designated by the board of education, instructing 
them concerning the methods employed to detect the first signs of 
communicable disease, and the recognized measures for the promotion 
of health and prevention of disease. The board of education may 
appoint more than one Medical Inspector. 

Article IX.— Section 122. 

UNVACCINATED CHILDREN. OR PERSONS EXPOSED TO CONTAGIOUS 

DISEASES MAY BE EXCLUDED. 

A board of education may exclude from school any child who shall 
not have been duly vaccinated, unless such child shall present a cer- 
tificate signed by a regularly licensed physician, that such child is an 
unfit subject for vaccination. No teacher or child, who shall be a 
member of a household in which a person shall be sick with small-' 
pox, diphtheria, scarlet fever, whooping cough or measles, or of a 
household exposed to contagion as aforesaid, shall attend any public 
school during such sickness, nor until the board of education shall 
have been furnished with a certificate from the board of health, or 
from the physician attending such sick person, certifying that all 
danger of communicating such disease by such teacher or child has 
passed. 

Article X.— Section 129. 

BUILDING PLANS AND DETAILS. 

The State Superintendent of Public Instruction shall procure 
architects' plans and specifications for school buildings, and full detail 
working plans therefor. In the preparation of such plans due regard 
shall be given to proper heating, lighting, ventilating and other 
hygienic requirements. Said plans and specifications shall be approved 
by the State Board of Education, and shall be loaned to any district 
desiring to erect a new school building. 



APPENDIX TO THE MINUTES. II9 

Section 130. 

approval of plans by state board. 

In order that due care may be exercised in the heating, lighting, 
ventilation and other hygienic conditions of public school buildings 
hereafter to be erected, all plans and specifications for any such 
proposed school building shall be submitted to the State Board of 
Education for suggestion and criticism before the same shall be 
accepted by the board of education of the district in which it is pro- 
posed to erect such building. 

Section 131. 

DOORS. 

In any school house of two or more stories in height, the doors 

leading from the class-rooms to the corridors, and from said corridors 

to the street or to the ground surrounding such school house shall 

open outwardly. All swing-doors shall have plate-glass windows of 

suitable dimensions. 

Section 132. 

requirements in erecting school houses. 

In order that the health, sight and comfort of the pupils may be 
properly protected, all school houses hereafter erected shall comply 
with the following conditions : 

I. Light shall be admitted from the left, or from the left and rear 
of the class-rooms and the total light area must, unless strengthened 
by the use of reflecting lenses, equal, at least, twenty percentum of 
of floor space. 

II. School houses shall have in each class-room, at least, eighteen 
square feet of floor space and not less than two hundred cubic feet of 
air space per pupil. All school buildings shall have an approved 
system of ventilation by means of which each class-room shall be 
supplied with fre^h air at the rate of not less than thirty cubic feet per 
minute for each pupil. 

III.— All ceilings shall be at least twelve feet in height. 

IV — All stairs, except cellar stairs, shall be not less than four feet 
in width, and shall have intermediate landings. The several flights of 
stairs shall be inclosed by brick walls or by partitions of slow-burning 
construction, and without open well holes. The risers of stairs shall 
not exceed seven and one-half inches in height, and the treads shall 
be at least ten inches in width, exclusive of the projecting nosings. 



I20 MEDICAL SOCIETY OF NEW JERSEY. 

V. — Every school house having eight rooms shall have two flights of 
stairs not less than four feet in width ; or. in lieu thereof, one flight of 
stairs situated near the center of the building, not less than six feet in 
width. 

VI. — Every school building having more than eight and less than 
sixteen rooms, shall have two flights of stairs not less than five feet 
in width. 

VII. — Every school house having sixteen or more rooms shall have 
three flights of stairs, not less than four feet in width ; or, in lieu 
thereof, two complete flights of stairs not less than six feet in width. 

VIII. — Every building more than one story in height shall have 
metal ceilings, wooden ceilings painted white, or some light tint or 
plastered ceilings on metal lath. 

The passage of a school law providing for the appointment of a 
medical inspector in locations in which such an officer is desired, and 
placing the officer under the supervision of the Board of Education, is 
an important step in the right direction. The educational boards 
must have considerable latitude in defining the duties of such an 
inspector, for the law is neither explicit nor definite. It does not 
specificially provide for the exclusion from school attendance of pupils 
who may be suffering from any form of contagious or communicable 
disease, except small-pox, diphtheria, scarlet fever, whooping cough 
or measles, although it might be inferred that the medical inspector and 
others in authority could by virtue of their specified duty to the pupils 
in general, exclude such cases. It in no way indicated that the 
medical inspector shall possess any authority to regulate and control 
the hygienic condition of the building, although the Board of Educa- 
tion, in defining his duties, might include such supervision. It does 
not refer definitely to the systematic examination of the eyes and ears 
of all pupils. In fact the whole matter seems to be left in the hands 
of the Board of Education. In this condition the law would seem to 
permit of almost any construction, and provide for the performance of 
any duty by the medical inspector. It cannot, however, prove to be 
entirely satisfactory, for the reason that no universal system will be 
adopted and the local rules will be of such variety, in accordance 
with the ideas of different educational boards, that much of the benefit 
to be derived from the passage of such laws and the appointment of 
such officers will be lost to the schools of the State. 

The Committee would recommend that the State Board of Educa- 



APPENDIX TO THE MINUTES. 121 

tion be requested to formulate and issue in circular form a definite set 
of rules for the guidance of local boards of education in prescribing 
the duties of medical inspector, in case such officer is appointed. 

Respectfully submitted, 

WALTER B. JOHNSON. Chairman. 
RICHARD C. NEWTON. 



Report of Committee on Abuse of Medical 

Charity. 

Mr. President : 

In view of the fact that last year's report from this committee was 
laid upon the table for further consideration at this meeting, it was 
deemed unwise by your committee to go into expense for legal advice 
in formulating a legislative act bearing upon the abuse of medical 
charity in this State, until the opinion of the members of this Society 
was better known. Your committee wishes to make its report now 
rather in the form of a supplement to that of last year. 
. This subject, in the opinion of this committee, is one of vital 
importance on the broad ground of morals, lowering as it must the 
self-respect of many who need medical aid, affording no means of 
compensation for services by those not entirely destitute, and being a , 
source of waste of large sums of moneydonated by those charitably 
inclined. In New York State, where legislative action has been taken, 
the success of the law has not been fully tested, but it promises to be 
effectual as soon as its provisions are fully understood by the various 
institutions it is intended to reach. 

Your committee is convinced that nothing short of legislative con- 
trol will universally lessen the growth of this social ?vil, and it appre- 
ciates the importance of lodging this matter in the hands of a body 
similar to the State Board of Charities of New York State, consisting 
of gentlemen of importance who shall be invested by such authority 
from the State as will render the execution of laws regulating State 
charity at least possible. We therefore recommend the formulation 
of a bill for presentation to the State Legislature, to authorize the 
creation of a State Board of Charities, whose powers shall include the 
production of rules and regulations for the prevention of the abuse of 



122 MEDICAL SOCIETY OF NEW JERSEY. 

medical charity, this board to be appointed by the Governor of the 
State, to consist of twelve (12) members, one-half laymen and one- 
half physicians, and all to serve gratuitously. 

Respectfully submitted, 

T. Y. SUTPHEN, Chairman, 
Geo. H. Balleray, 
F. D. Gray, 
J. S. Baer. 



Report of Committee on Entertainment of the 
American Medical Association. 

To the Medical Society of New Jersey : 

Gentlemen :— The Committee on the Entertainment of the Ameri- 
can Medical Association begs leave to present the following report : 

The committee met at Atlantic City on September 7, 1899, and 
organized by electing Dr. Philip I. Marvel, Chairman, a^d Dr. George 
Evans Reading, Secretary. The following were appointed as chairmen 
of sub-committees with power to appoint their own assistants : Dr. 
Pierson, Finance ; Dr. Waddington, Reception ; Dr. McAllister, Enter- 
tainment ; Dr. Reading, Decorations ; Dr. Hollingshead, Information, 
and Dr. Halsey, Invitations. 

The committee again met on November 24, 1899, in Philadelphia. 
At this meeting. Dr. James S. Green, of Elizabeth, was elected Treas- 
urer, and the committee was enlarged by making the officers of the 
Medical Society of New Jersey and the presidents of the various 
district societies members ex-officio. 

The committee again met at Trenton on January 22, 1900. At this 
meeting the original plan of having one large reception was found to 
be impracticable, owing to the fact that we could not obtain the ex- 
clusive use of either of the ocean piers, and there was no other place 
large enough for such a function. It was then decided to have several 
smaller entertainments occurring on the same evening and this plan 
was carried out. The committee secured the use of parts of each 
pier and of the palm garden of the Hotel Isleworth, and gave a 
series of entertainments, including a band concert, a vaudeville enter- 
tainment, a reception followed by a dance and a smoker. The various 
events passed off well and were, the committee thinks, thoroughly 
enjoyed by the members of the American Medical Association. 



APPENDIX TO THE MINUTES. 



123 



As the Committee of Arrangements of the American Medical 

» 

Association was to use the same rooms on the following evening, they 
kindly offered to share the expense of decorating them, and this con- 
tributed largely to the favorable financial showing which your com- 
mittee is able to make. 

FINANCIAL REPORT. 



RECEIPTS. 

Atlantic Society. ... $102.00 



Bergen 


«4 


....... . 100.00 


Burlington 


<l 


87.00 


Camden 


4< 


104.00 


Cape May 


48.00 


Cumberlam 


1'^ 
<< 


I 24.00 


Essex 


601.00 


Gloucester 


«« 
<« 


104.00 


Hudson 


240.00 


Hunterdon 


«t 


76.00 


Mercer 


«« 


174.00 


Middlesex 


<» 


..... ... 67.00 


Monmouth 


H 
If 


108.00 


Morris " 


120.00 


Passaic 


l< 


288.00 


Salem 


• f 


35.00 


Somerset 


4< 


92.00 


Union 


4< 


321.00 


Warren 


44 


83.00 


Total 




ft2.874..00 



*t 



tt 



44 



44 



it 



DISBURSEMENTS. 

Warrant No i $175-53 

No. 2 555.75 

No 3 155.00 

No. 4 144.55 

No. 5 5.00 

No. 6 25.00 

No. 7 67.50 

No. 8 77.00 

No. 9 168.95 

No. 10 13.75 

No. II 5.50 

No. 12 155.00 

No. 13 4.44 

No. 14 65.00 

No. 15 39.60 

No. 16 36.35 

No. 17 27.50 



44 



*t 



14 



44 



4< 



<4 



44 



Balance on hand $1,152.58 



The balance has been turned over to Dr. A. Mercer, Treasurer of 
the Society, in accordance with the resolution passed at the final 
session of the Society held at Atlantic City. 

Respectfully submitted on behalf of the committee, 

George Evans Reading, Secretary, 



ESSAY. 



BY " FIAT LUX."* 



Hydrophobia. 

The public has very naturally and very rightly shown deep interest 
in the investigations into the nature and possible cure of hydrophobia. 
Is there any such disease ? Many authorities say that hydrophobia 
in man — rabies hominis — is rare or does not exist. . There are those 
who maintain that hydrophobia — as a disease, due to a peculiar poison 
contained in the saliva of a rabid animal — has no real existence ; that 
the poison is a fiction, and that the symptoms supposed to be pro- 
duced by it are really due to the imagination and to the influence of 
sympathy, with the faculty of imitation, the whole being intensified 
by morbid fears. On this hypothesis it would be impossible to 
account for the occurrence of this disease in infants after being bitten. 

Persons bitten by animals afflicted with this disease often develop 
certain peculiar symptoms similar to those occurring in rabies in the 
carnivora. These symptoms are nearly always followed by a fatal 
issue. It thus appears that a disease acting so fatally can not be non- 
essential or due to the imagination of its victims. Nearly all agree 
that the disease called rabies exists in the canine, feline, vulpine, lupine 
and other species of carnivora. 

Rabies, as affecting the dog and other animals, was known to the 
ancients, and is spoken of by Aristotle, Pliny and Horace ; but it 
does not seem to have been then so virulent in its nature or alarming 
in its consequences. It was prevalent on the continent of Europe 
two or three centuries ago, but was comparatively rare in Britain till 
the eighteenth century. This malady stands almost alone in this, 
that all animals seem liable to its attack. 

From the time of Aristotle to 1880, so little was hydrophobia under- 
stood, and to so small an extent had it been studied, that it was 



*Dr. Alonzo I. Hunt, Hamilton Square, N. J. — Awarded honorable mention 
by Fellows' Prize Essay Committee. 



126 MEDICAL SOCIETY OF NEW JERSEY. 

regarded by a certain number of skilled physicians as a condition of 
the nervous system brought about by the infliction of a punctured 
inflammatory wound, in which the action of a specific virus or poison 
took no part. It was, in fact, by some physicians, regarded as a 
variety of lockjaw or tetanus. 

. The number of cases of hydrophobia reported in England, France, 
Germany, Austria and the United States has varied a good deal each 
year since the time when statistics of disease were instituted by the 
governments of these several countries ; but its occurrence is suffi- 
ciently frequent at certain periods to excite the greatest anxiety and 
alarm. In England, as many as thirty-six persons died from the 
disease in 1866. In France, 288 persons were its victims in 1858, and 
in Prussia and Austria it is more frequent than in England. In 
Russia it is common. In America the disease is said to be rare. 
Dulles could collect only seventy-eight cases in the five and one-half 
years ending December 31, 1893, but the Pasteur Institute claims to 
have treated, from January i. 1890, to January i, 1900, 1,367 cases 
of hydrophobia; 715 of these cases were proven to be true hydro- 
phobia. Owing to the diversity of opinion in this country regarding 
the disease, it is almost impossible to obtain reliable statistics. 

The general belief, both among medical men and veterinary, sur- 
geons, as well as the public, has been that the condition known as 
hydrophobia in man does not follow from any ordinary bite or injury, 
but in order to produce it the human subject must be bitten by a dog. 
wolf, pig or other animal which is suffering from a well-marked dis- 
ease known as ** rabies." What it is which starts " rabies " amongst 
dogs is not known ; but the condition so named is communicated by 
" rabid " or mad dogs to other dogs, to pigs, to cattle, to horses and 
to all warm-blooded animals— even birds. The curious statement 
has been made by Dr. Alsup, of Tennessee, who says that hydrophobia 
is a physiological product of the ordinary polecat. His observations, 
extending over a period of fifteen years, convinced him that from the 
skunk originates all our hydrophobia. He has collected 149 cases of 
hunting dogs that were bitten by polecats, and 142 developed hydro- 
phobia. The shortest period of incubation was three days, the longest 
eighteen months; the average period of incubation in these cases 
was forty-three days. 

In California and other western States, where people are often 
bitten by the ordinary polecat, he has noticed for many years that 



APPENDIX TO THE MINUTES. \2^ 

these cases nearly always end in fatal hydrophobia. He confined a 
skunk, and five dogs were securely muzzled and set on the skunk at 
different times. All of them were bitten, some of them repeatedly. 
Every one of these dogs developed well marked cases of hydrophobia, 
and the dogs bitten oftenest were first to show signs of rabies. I 
can find no further information or observations along this line other 
than those of Dr. Alsup. 

Any animal afflicted with rabies is capable, by its bite, of communi- 
cating the disease to other healthy animals. Rabies in a dog is 
recognized without difficulty by the skilled veterinarian. The disease 
has two varieties known as the "dumb madness" and "raving mad- 
ness," and it is held by veterinarians to have two modes of origin, 
viz., spontaneous, and as the result of infection from another rabid 
animal. It is quite permissable to doubt the spontaneous generation 
of rabies in any given case, although it must be admitted that the 
disease had a beginning and that it is not improbable that whatever 
conditions favored its first origin are still in operation, and likely to 
result in a renrwed creation of the disease. Infection from another 
rabid animal is the more likely mode of origin, as the disease is niost 
probably due to a micro-organism not yet isolated. 

The disease is of world-wide distribution and is known both in the 
torrid and arctic regions, though much more common in temperate 
regions than in either of the extremes of climate. There are some 
striking cases of certain well-peopled regions of the earth's surface in 
which it is at present unknown ; no case appears to be on record of 
this occurrence in Australia, Tasmania or New Zealand. It is a mis- 
take to suppose that the disease is more common in very hot weather 
than in cooler weather, or that great cold favors it. The climate 
appears to have nothing to do with it, or rather, it should be said, is 
not shown to have anything to do with it. 

The following is an abstract of Prof. Fleming's admirable treatise 
on rabies and hydrophobia (London, 1872): 

" It is a great and dangerous error to suppose that the disease (in 
the dog) commences with signs of raging madness, and that the 
earliest phase of the malady is ushered in with fury and destruction. 
The animal at first becomes gloomy and dull ; seeks to isolate itself, 
and chooses solitude and quietness, hiding in out of the way places, 
or under tables and chairs and other pieces of furniture ; but, even 
then, it cannot rest ; it is uneasy ; lies down for a few minutes and is 



128 MEDICAL SOCIETY OF NEW JERSEY. 

soon asleep. All at once it jumps up in an aggitated manner, walks 
hither and thither several times, again lies down and assumes a 
sleeping attitude, but has only maintained it for a few minutes, when 
it is once more moving about. • seeking rest but finding none,* At 
times it seems to be more lively and displays an extraordinary amount 
of affection. Sometimes, in pet dogs, there is evinced a disposition to 
pick up and carry away small articles, such as straws, threads, etc. 
At this period no propensity to bite is observed, the animal is friendly 
with its master, and recognizes his voice, though not so readily as 
before, nor with the same pleased countenance. 

*' A mad dog has not a dread of water ; but, on the contrary, will 
greedily swallow it. As long as it can drink it will satisfy its ever 
ardent thirst ; even when the spasms in its throat prevent it swallow- 
ing, it will, nevertheless, plunge its face deeply into the water, and 
appear to gulp at it. When the desire to bite, which is one of the 
essential characters of rabies at a certain stage, begins to manifest 
itself ; the animal, at first attacks inert bodies, gnawing wood, leather, 
its chain, carpets, straw, clothes, etc., and accumulates in the stomach 
the remains of all the substances it has been tearing with its teeth. 

"An abundance of saliva is not a constant symptom in rabies in the 
dog. Sometimes its mouth is humid, and sometimes it is dry. Be- 
fore a fit of madness, the secretion of saliva is normal ; during this 
period it may be increased, but towards the end of the malady it 
generally decreases. 

** The animal often expresses a sensation of pain or inconvenience 
during the spasm in its throat by using its paws on the side of its 
mouth, like a dog which has a bone lodged there. In * dumb mad- 
ness ' the lower jaw is paralyzed and drops, leaving the mouth open 
and dry. The tongue is frequently brown or blue colored, one or 
both eyes squinty, and the creature is ordinarily helpless. The voice 
is always changed in tone, the sound is husky and jerking; in dumb 
madness it admits no cry of pain, or sign, as when it suffers or is 
afraid in health. 

"A mad dog is very much enraged at the sight of an animal of its 
own species, even when the malady might be considered as yet in a 
latent condition, as soon as it sees another dog, it shows this strange 
antipathy and appears desirous of attacking it. This is a most im- 
portant indication. The animal often flees from home when the 
ferocious instincts commence to gain an ascendency, and, after two or 



APPENDIX TO THE MINUTES. 1 29 

three days' wandering, during which it has tried to gratify its mad 
fancies on all living creatures it has encountered, it often returns to 
its master to die. At other times it escapes in the night, and after 
doing as much damage as its violence prompts it to, returns again to- 
wards morning. The distance a mad dog will travel, even in a short 
period, is sometimes very great. 

** The furious period of rabies is characterized by an expression of 
ferocity in the animal's physiognomy, and by the desire to bite when 
ever an opportunity offers. The paroxisms of fury are succeeded by 
periods of comparative calm, during which the appearance of the 
creature is liable to mislead the uninitiated as to the nature of the 
malady. 

*' The mad dog usually attacks other creatures rather then man, 
when at liberty. When exhausted by the paroxysms and contentions 
it has experienced, it runs in an unsteady manner, its tail pendant and 
head inclined towards the ground, its eyes wandering and its mouth 
open, with a bluish-colored tongue protending. Though no longer 
aggressive, it will yet bite everyone, man or beast, that it can reach 
with its teeth. The mad dog that is not killed perishes from paralysis 
and asphyxia. To the last moment, the desire to bite is predominent, 
€ven when the poor creature is so prostrated as to appear to be trans- 
formed into an inert mass." 

Such is the pathetic account of the features of this terrible malady 
as seen in man's faithful companion. 

We will now, for a moment, look at the symptoms and course of 
the disease as exhibited in man, where it produces a condition so 
terrible and heart-rendering to the onlooker, that it becomes a matter 
of astonishment that mankind has ever ventured to incur the risk of 
acquiring this disease by voluntarily associating with the dog, and a 
matter of the most urgent desire that some great deliverer should arise 
and show us how to remove this awful thing from our midst. 

In both the dog and the man the disease is traced to the inflction of a 
bite or scratch at a more or less distant period by an animal already 
suffering from " rabies." The length of time which may elapse be- 
tween the bite and the first symptom of ** rabies '* in the dog, or of 
hydrophobia, as it is termed, when developed in man, varies. Briefly, 
it may be stated, that the interval in a dog varies from seven to one 
hundred and fifty days, and is as often a longer as a shorter period. 
In man, on the other hand, two-thirds of the cases observed develop 
within five weeks after the infliction of the bite. Hydrophobia may 
9 



I30 MEDICAL SOCIETY OF NEW JERSEY. 

show itself as early as the tenth day after the infection ; it is very rare^ 
indeed, though not unknown, that this period of incubation has ex- 
tended over a whole year. Reputed cases of an incubation period of 
two, five or even ten years, may be dismissed as improbable and 
unsupported by evidence. The uncertainty which this well-known 
variation in the incubation period produces, is one of the many dis- 
tressing features of the disease in relation to man ; for often the 
greatest mental tortue is experienced during this delay in persons who 
after all, have not been actually infected. 

•* In many respects," says Prof. Fleming, *• there is a striking 
similarity in the symptoms manifested in the hydrophobic patient and 
the rabid dog, while in others, there is a wide dissimilarity. These 
resemblances and conditions we will note as we proceed to briefly 
sketch the phenomena of the disease in our own species." 

The earliest indication of the approaching disease is a sense of pain- 
in or near the seat of the wound. If not acute pain, there is some 
unusual sensation, such as aching, tingling, burning, coldness or stiff* 
ness in the cicatrix ; which usually in these circumstances, becomes of 
a red color, even discharging a thin ichorous fluid instead of pus. In 
the dog, as we have observed, the peculiar sensation in the seat of the 
inoculation, has at times caused the animal to gnaw the part most 
severely. 

With these local symptoms some general nervous disturbance is 
generally experienced. The patient becomes dejected, morose, irri- 
table and restless ; bright and sudden light is disagreeable to him ; 
his sleep is troubled, and he often starts up ; pains are experienced in 
various parts of the body and signs of digestive disorder are frequent. 
After the continuance of one or more of these premonitory symptoms 
for a period varying from a few hours to five or six days, and without 
all or even many of them being observed, the patient becomes sensible of 
a tightness or stiffness about the throat, rigors supervene, and, in 
attempting to swallow, he experiences some difficulty, especially with 
liquids. This may be considered as really the commencement of the 
attack in man. 

The difficulty in swallowing rapidly increases, and it is not long be- 
fore the act becomes impossible ; and soon the patient dreads the 
thought of liquid. Singular nervous paroxysms become manifest, and 
sensations of stricture or oppression are felt about the throat and 
chest. The breathing is painful and embarassed, and there is a sense 
of impending suffocation and of necessity for fresh air. 



APPENDIX TO THE MINUTES. I3I 

The most marked symptoms consist in a horribly violent convul- 
sion or spasm of the muscles of the larynx and gullet, by which 
swallowing is prevented ; and, at the same time, the entrance of air to 
the wind-pipe is greatly retarded. Shuddering tremors, sometimes 
almost amounting to general convulsions, run through the whole 
being, and a fearful expression of anxiety, terror or despair is depicted 
on the countenance. 

The paroxysms are brought on frequently by the attempt to swallow 
liquids, after which, to suggest the idea of drinking to the patient will 
throw him into convulsive spasms. He is perfectly rational, feels 
thirsty, tries to drink, but the liquor has no sooner touched his lips, 
when he draws back, sometimes exclaiming that he cannot drink ; his 
face expresses pain ; his eyes are fixed, and his features contracted ; 
his limbs shake and his body trembles. The paroxysms last a few 
seconds, and then he gradually becomes tranquil ; but the least touch, 
nay a mere vibration of the air, is enough to bring on a fresh attack. A 
special difference between hydrophobia and rabies, is the frequent 
dread of water in the former. 

Another characteristic feature of the disease in man is a copious 
secretion of viscid, tenacious mucus in the fauces, the " hydrophobic 
saliva ;" this the patient spits out with a sort of vehemence and rapid- 
ity upon everything around him. This, to a bystander, is sometimes 
one of the most striking phenomena of the case. The mind is some- 
times calm and collected in the interval between the paroxysms, and 
consciousness is generally retained ; but in most cases there is more 
or less irregularity, incessant talking, and, occasionally, fits approach- 
ing to insanity come on. The mental aberation is often exhibited in 
groundless suspicion or apprehension of something extraneous. 

In comparitively rare instances he gives way to a wild fury, like that 
of a dog in one of its fits of rabies ; he roars, howls, curses, strikes at 
persons near him, rends or breaks everything in his reach, bites others 
or himself, till, at length, exhausted, he sinks into a gloomy, listless 
dejection, from which another paroxysm arouses him. 

Remissions of the symptoms sometimes occur in the course of the 
complaint, during which the patient can drink and take food, though 
with some difficulty. Toward the close such a remission is not 
uncommon, with an almost complete absence of the painful symptoms ; 
so that the patient and the physician begin to entertain some hope. 



132 MEDICAL SOCIETY OF NEW JERSEY. 

But if the pulse is now felt, it is found to be extremely feeble ; and, 
sometimes, almost, if not quite, imperceptible. During this apparent 
relaxation of the disease the patient occasionally falls into a sleep, 
from which he only wakes to die. 

Death commonly results from spasm of the respiratory muscles, the 
patient dying asphyxiated. Often death is sudden from failure of 
cardiac action. Paralytic symptoms manifest themselves before death 
in some instances. The disease, in man, almost invariably terminates 
fatally ; and, usually, between the second and fifth day after the 
symptoms above described have been observed, though it sometimes 
runs until the ninth day. 

In the Transactions of the State Society for 1898, Dr. Darnall, of 
Atlantic City, reported a case of a colored man aged 23, well-built 
and strong, who had never been sick a day in his life before. During 
July he was employed as keeper of the city dog pound, and was bitten 
once or twice on the arms and once on the leg. On October 27, he 
was taken sick with occasional attacks of vomiting and gagging, but 
no other symptoms appeared. He had no pain anywhere, nor elevated 
temperature ; pulse normal ; but with a rather excited action. He 
said his hands were numb ; a spasmodic action of the breathing 
muscles was noticed occasionally, and, at such times, the breath came 
in short jerks. Later he became quite noisy with it, and would 
actually shout at times. He was much excited about himself, and 
pleaded for something to be done for him. His friends had of late 
been discussing the symptoms of hydrophobia quite freely in his 
presence. The doctor thought that he had, perhaps, worked himself 
up to a nervous pitch under ihe influence of fear, especially as all the 
symptoms present at this time could be explained by nervousness. 
The scars from the dog bites, he said, were cauterized at the time 
they were received, and were now in a perfectly healthy condition, 
and free from pain. He could not swallow water, but could swallow 
his medicine without much difficulty. The spasmodic attacks of 
breathing were more frequent and intensified. Expectoration, 
thick and ropy, and more profuse. An attempt to drink water now, 
caused him to clutch at his throat. His conversation was perfectly 
sane. At twelve o'clock, twelve hours after the doctor first saw him, 
his condition was aggravated in every respect, though he never com- 
plained of any paiii, not even a headache, and had no fever. Expec- 
toration was now very frequent. The expression of his eyes was one 



APPENDIX TO THE MINUTES. 1 33 

of wild fear and dread ; an attempt to drink water at this time caused 
intense and indescribable contortion. Not long after this he became 
^o unmanageable that the patrol had to be called, and he was placed 
in a cell at the police station. He now had delusions and hallucina- 
tions of various kinds, for a description of which I refer to rhe doctor's 
excellent report. The condition of this man at 8.30 P. M., was fear- 
ful, expectoration was now bloody, tenacious and frequent. He roared 
and cursed. This continued through the night until the following 
morning, when his death occurred from sheer exhaustion. Until fifteen 
minutes of his death, his talk was sensible. Neither chloral, bromides 
nor morphine had the slightest effect in controlling the paroxysms. 

The post-mortem revealed considerable congestion of the arachnoid ; 
a small clot in the membrane at the base of the cerebellum, but no 
congestion of the cortex or the brain. There was an effusion in each 
lateral ventricle, beyond this the organs were normal. 

In the right and left ventricle of the heart were found '• chicken-fat '^ 
clots, showing progressive heart failure, with both lungs congested ; 
some hemorrhagic extravasation, kidneys slightly congested, bladder 
full, liver and spleen normal. 

- In concluding his description of the case, the doctor truly and justly 
says : " It fits the description of no other condition or disease that I 
have been able to find in medical literature." 

It is held by veterinarians that rabies in a dog is invariably fatal^ 
and one test of the presence of the disease is a fatal termination to 
the symptoms ; inasmuch as it is very usual to kill the dogs suspected 
of rabies, without waiting to actually prove that they were suffering 
from the disease ; and further, inasmuch as dogs not suffering from 
rabies are sometimes savage and snappish, and people are bitten by 
them, thus leading to the assumption that the persons so bitten have 
incurred the risk of developing hydrophobia. There is an absence of 
trustworthy information, first, as to the actual number of dogs annu- 
ally affected with rabies in any given country; second, as to the 
number of persons effectively bitten by really rabid dogs, who have 
acquired hydrophobia as a consequence of the bite. The dogs appar- 
ently suffering from rabies were killed before it was actually proven 
that they were suffering from rabies, and the human beings bitten are 
treated with caustics and excisions before it is proved that they really 
are in danger of developing hydrophobia, and it is not known in case 
of escape \Vhether the danger was ever really incurred. 



134 MEDICAL SOCIETY OF NEW JERSEY. 

The extreme anxiety to avoid the awful consequences not unfre- 
quently following the bite of a rabid dog, has produced a course of 
action which, whilst it is undoubtedly accompanied by the destruction 
of many innocent dogs, and by the affliction of acute pain and mental 
anguish upon human beings who, could they know the truth, have no 
cause for alarm, has also at the same time necessarily prevented the 
acquisition of accurate knowledge with regard to the disease in im- 
portant respects, especially as to the conditions of its communication 
from dog to man. According to the lowest estimate, where care has 
been taken to exclude cases in which there is not sufficient reason for 
supposing the offending dog to have suffered from rabies, of every six 
persons bitten one dies ; /. ^., but one bite out of six produced the 
recognized symptoms of hydrophobia. Thus the symptoms in the 
five cases were only similar and not recognized symptoms, or not 
severe enough to produce the recognized symptoms, as recovery after 
the development of the hitherto recognized symptoms is unknown. 
This is a mortality of seventeen per cent. 

The large proportion of escapes as compared with deaths is attrib- 
uted to the following facts: (i) That the wounds inflicted have not 
been sufficiently deep to introduce the poison into the system ; 

(2) From the fact that bites are inflicted through the clothing; 

(3) From the rendering of timely surgical treatment, and (4) to the 
fact that the dogs may, in a certain proportion of the cases, have been 
wrongly suspected of suffering from rabies. At the same time there 
is no doubt that animals, and presumably men, are sometimes en- 
dowed with an immunity from rabies. This has been proven experi- 
mentally by repeatedly inoculating a dog with the saliva of a rabid 
dog, which proved fatal to other animals which were experimented 
upon at the same time, whilst the particular dog in question always 
proved refractory or not liable to the disease. No estimate has been 
at present formed of the proportion of dogs thus free from liability 
to the disease, but it must be very small, perhaps not one per cent. 
On the other hand it is undeniable that there is a high probability 
that such immunity exists among human beings, and it is possible 
that the proportion of individuals liable to the infection, as compared 
with those "immune," "refractory" or "non-liable," is less among 
human beings than among dogs. Such a constitutional immunity may 
therefore possibly explain, to a certain extent, the fact that out of one 
hundred cases of dog bite, the dogs being supposed but not demon- 
strated to be rabid, only sixteen acquire hydrophobia. 



APPENDIX TO THE MINUTES. 1 35 

The anatomical characteristics are fluidity of the blood, such as is 
met with after death from acute septic diseases ; and occasionally red- 
ness of the throat and pharynx, enlargement of the salivary and other 
glands ; together with, in some cases, evidence of congestion of the 
brain and spinal cord ; these constitute the chief morbid appearances 
visible to the naked eye. The mucous membrane of the fauces, 
larynx, trachea, pharynx, oesophagus, stomach and intestines may be 
swollen, congested or hyperaemic ; the spleen is frequently enlarged 
and congested ; hence the disease has often been mistaken for anthrax. 
The lungs are generally clotted with blood, the kidneys and bladder 
may be hyperaemic and the bladder is usually emptied and contracted. 

Williams says : *' On the lower surface of the medulla oblongata, at 
the origin of the seventh, eighth and ninth pairs of nerves, the 
membranes are generally highly congested, thickened, softened and 
matted together." 

'* The brain substance may be soft and pliable, there is rarely con- 
gestion ; and as a rule the brain is pale and bloodless '* (Fleming.) 

The microscope has shown that there is evidence of inflammation, 
congestion and leucocytal infiltration in the salivary glands (Coats), 
and that •' minute changes in the nerve centres are almost constantly 
to be found (Clifford, Allbut, Hammond, Benedikt, Coats and Gowers). 

Of nine cases examined by Gowers, the microscopic changes in 
seven were distinct and in character and position ; so far characteristic 
that, given the fact of an acute disease; a post-mortem diagnosis 
might in this proportion of cases be made with certainty by the 
microscope. The essential changes consist in the accumulation of 
leucocytes around the vessels and their infiltration into the adjacent 
tissue. This change having a special distribution, being either con- 
fined to or most intense in the region of the medulla, which is con- 
tiguous to the lower part of the fourth ventricle, that is. the neighbor- 
hood of the respiratory center. Here we have, also, the center for 
deglutition. The change is most intense in the hypo-glossal, glosso- 
pharyngeal and vagal nuclei and their neighborhood. There is little 
or no change in the upper part of the medulla, corpora quadrigemina, 
cerebellum or basal ganglia. It is, however, often very marked in the 
spinal chord. 

Minute extravisations are common, partly mechanical. In the most 
affected regions traces of ante-mortem clots and even inflammation 
of the walls of the minute vessels may be found in some cases. 



136 MEDICAL SOCIETY OF NEW JERSEY. 

Perivascular areas of disintegration are common, but such frequently 
occur apart from hydrophobia or any other disease. Changes in the 
nerve elements themselves consist in a granular degeneration of the 
gangloin cells of the regions chiefly diseased. In the dog the changes 
are quite similar in character and distribution. 

Theref is but little doubt that the virus of hydrophobia is a micro- 
organism, although not yet detected. It is supposed that the organ- 
isms or their germs frequently remain in the tissues near the v^^ound, 
and only become dislodged at a later period to reach the nerve centers 
and there develop (Pasteur). The symptoms indicate primary influ- 
ence on thejnerve centers, especially on the respiratory region of the 
medulla, spreading more v^^idely in its ultimate action, both in the 
medulla and to the brain and chord. 

The vascular changes, from their variability and occasional absence, 
are probably secondary effects of the disturbed action of the nerve 
structure, produced by a poison carried by the blood. The virus has 
been thought to ascend by the nerves, but this is not likely, although 
germsl may simultaneously enter the peripheral nerves and develop- 
there, since the poison has been found to be abundant in them. 
(Dowdeswell). 

The first effect of the poison is probably to lessen the resistance- 
of the medullary centres. Their action becomes spasmodic and is 
excited with undue readiness. The excessive action of the medulla 
and spinal chord finds its counterpart in the cortex and the delirium 
which results. At a later stage this gives place to depressed activity 
which may end in paralysis and coma when general. 

The secondary vascular changes may have their own effects by the 
infiltration of leucocytes, the tissues may be broken up and what are 
practically minute points of suppuration may result. If the part 
damaged is important, grave consequences may ensue. The neucleus 
of the pneumogastic is often so damaged, and from this or the later 
depression we can understand the occurrence of cardiac failure. The 
mental excitement no doubt acts upon and increases the irritability of 
the medulla (Putnam) conversely, the disturbance of the latter may 
help to determine the character of the mental disturbance due to the 
poison of hydrophobia. 

The diagnosis of hydrophobia is obtained with quite some difficulty. 
The best means of diagnosis are the positive history of a bite from a 
probably rabid animal, with the prolonged period of incubation of 



APPENDIX TO THE MINUTES. I37 

hydrophobia. The system of greatest diagnostic value is the respira- 
tory spasm excited by attempts to swallow, increasing until it resem- 
bles a convulsive action and accompanied afler a time by mental 
disturbance. In hydrophobia the spasms affect the muscles of deglu- 
tition and not those of mastication as in tetanus, and are not tonic in 
their chaiacter, and that the respiratory embarassment is due to spasm 
of the laryngeal muscles and not to those of the chest. 

This will suffice to distinguish between these affections. When 
the meiltal disturbance occurs early, the affection may be confounded 
with acute mania. The association with slight respiratory spasm is 
still the most important diagnostic indication. In cases in which this 
symptom is absent the diagnosis is a matter of great difficulty and 
can only be made by the history of the antecedent bite, by the rapid 
course of the disease, by the association with other convulsive phe- 
nomena and with salivation. Organic brain diseases accompanied by 
delirium and convulsions occurring after a bite, have been mistaken 
for hydrophobia, as in one case in which the nature of the disease 
was only discovered when, after death, a meningeal hemorrhage was 
found. Here also the respiratory spasm was absent. 

Mere mental excitement directed to the symptoms of the disease 
may determine dysphagia simulating that of the genuine disease, 
pseudo-hydrophobia, often accompanied by delirium, excitement. The 
spasm, however, is not of the true respiratory character of hydro- 
phobia. The patient generally recovers. In some cases of genuine 
hydrophobia the influence of the patient's mental state has been 
clearly traceable, even in the early symptoms, and it is probable that 
many true cases have been regarded as spurious and even published 
as such. Death is not likely to result except from the genuine disease. 

Hydrophobia is practically fatal, but not certainly so. Cases which 
were without doubt true hydrophobia have recovered. Cases differ in 
the intensity and rapidity of their course; and. the less rapidly the 
symptoms are evolved the greater is the hope, slight though this 
hope is, yet the patient may survive. The prognosis is better the 
longer the spasms remain limited ; it is worse if there are signs of 
exhaustion or heart failure, general convulsions,, much mental dis- 
turbance. 

The duration of hydrophobia is usually from one to four days ; it 
generally runs its course in from three to six days, and some cases 
which have recovered the duration has been ten days. The common 



138 MEOICAL SOCIETY OF NEW JERSEY. 

•cause of death is exhaustion, due to attacks of fury, and convul- 
sions often aided by manifest heart failure. If the patient survives 
long enough a gradual ascending paralysis takes place, and often a 
patient has died asphyxiated in a paroxysm of respiratory spasm ; 
partly perhaps from spasm of the glottus and without a general 
convulsion. 

A disease so imperfectly understood and of such doubtful origin 
must necessarily have many treatments. Even before the disease 
was known by the name of hydrophobia, curious treatments were 
used. Since the disease has been recognized to a certain extent by 
the medical profession, the average physician has been groping and 
searching for a specific for the disease. The best to my mind is the 
prevention of the disease. This means a measure to prevent the 
spread of rabies, which would almost prevent the development of 
hydrophobia in man. No dogs ought to be allowed to enter public 
buildings or travel in public streets or highways without a muzzle or 
under the control of their owner. If a rabid animal is at large, notice 
should be given of the fact to the neighborhood as soon as possible. 
All kennels, chains, collars and places with which the rabid animal 
has been connected should be scalded and disinfected. All animals 
affected with rabies should be killed at once and burned or buried 
deep. If any animal is suspected of being inoculated with rabies it 
should be confined for at least four months; should any signs of 
rabies occur, the animal should be immediately destroyed. If such 
animal has bitten any person it should not be destroyed until it has 
been positively discovered whether it was rabid or not. 

When a person has been bitten by an animal supposed to be rabid, 
the circulation in the part should be, if possible, at once arrested by 
a tight ligature above the place. The wound should be washed and 
allowed to bleed freely and then should be cauterized as speedily as 
possible. The best agent for this purpose is nitrate of silver; this 
should be used thoroughly and freely. The actual cautery applied 
freely and deeply is an efficient and ready means. If any time has 
elapsed, nitric acid or liquid carbolic acid is preferable. Without arrest 
of circulation cauterization after ten minutes has often failed. 

The name that will be forever connected with the treatment of 
hydrohobia is that of M. Pasteur, who discovered the mode of pre- 
venting the development of hydrophobia, both in the dog and in man, 
by inoculation. According to Pasteur, the virus of rabies is found 
chiefly in the spinal cord, though it also exists in other parts of the 
nervous system and in the salivary glands. His first experiment in 



APPENDIX TO THE MINUTES. 139 

Telation to rabies was made in December, 1880, when he inoculated 
two rabbits with the. mucus from the mouth of a child which had died 
oi that disease, As his inquiries extended he found that it was neces- 
sary to establish, by means of experiment, even the most elementary 
facts with regard to the disease, for the existing knowledge on the 
treatment of hydrophobia was extremely small or founded on tradi- 
ition. Pasteur briefly proceeded as follows : 

'* Having secured, by successive .inoculations upon rabbits, a virus 
which induces rabies after seven days' incubation, he prepared a series 
•of flasks in which the air was kept dry by caustic potassa. He put 
daily in one of these flasks a section of spinal cord freshly taken from 
the rabbit, dead or seven days rabies, and thus secured a series of 
viruses of gradual lessening strength. To protect a dog from the 
possibility of acquiring rabies from the bites of other rabid dogs, he 
injected hypodermically a syringe full of sterilized bouillon impreg- 
nated with a fragment of cord which had been drying long enough to 
lose all its virulence, the following day he repeated the injection with 
a portion of cord which had been kept two days' less time, on the 
third day with one of four days' less age, and so on, slowly increasing 
the virulence of the injection until the employment of the almost fresh 
cord completes the dog's insusceptibility to the poison. He advised a 
-similar plan in inoculating human beings, and believes that insuscepti- 
bility may be secured by prophylatic injection, even after the person 
has been bitten by a rabid dog, provided that the treatment is begun 
with sufficient promptness. In his first case, the course of inocu- 
lation occupied sixteen days, but he shortened the time to seven 
•days or less. In venturing on the delicate treatment of human beings, 
it seemed possible to Pasteur to rapidly produce a state of refractori- 
ness to the poison of rabies by using a virus of active rapidity, and so, 
^s it were, overtake the more slowly acting virus injected into the 
system by the bite of a mad dog. 

The first human being treated by Pasteur was a child, Joseph 
Meister, on July 6, 1885. Pasteur began with a cord that had been 
kept fifteen days ; cords of gradual increasing virulence were injected 
for the next ten days, and on the i6th of July, a cord of one day was 
<used. The boy recovered. 

He continued his treatment on 1,335 cases, between 1885 and 1886. 
He had a mortality of about one-half per cent., since then, his method 
■of treatment has given a mortality of about one per cent. 



I40 MEDICAL SOCIETY OF NEW JERSEY. 

A general principle appears to be, according to Pasteur, that, ii> 
regard to rabies, the longer the incubation period, the less the viru- 
lence of the virus, and the shorter the incubation period, the greater 
the virulence. 

Institutes, to carry out this method of treatment, have been estab- 
lished in various parts of the world. The statistics of the Pasteur 
Institute of New York, for the past ten years ending January, 1900, show 
1,367 cases treated, with a percentage of 0.66 ; of 1,367 persons treated 
(115^) were bitten on the head or face, 746 on the hands, 467 on other 
parts of the body. In 447 cases the animal having indicted the bite 
was proven rabid by inoculation. In 258 cases the animal was 
declared rabid by a veterinary examination, and in the remaining 652 
cases the animal disappeared, or had been shot, after having acted in 
such manner as to lead one to suspect rabies. 

At the Pasteur Institute, of Lyons, 372 cases were treated from 
November ist, 1897, to November ist, 1899. Among the 372 persons- 
treated, there was but one death ; this was a boy eleven years old, 
bitten on one hand, and treated on the following day, and who devel- 
oped rabies. While undergoing the treatment, the boy disobeyed the 
advice given and continued to do work, which was too great for his- 
strength. 

At the institute of Marseilles, i ,460 persons have been treated since its 
opening five years since ; six deaths occurred (40^); in 307 cases, the 
animals had been proven rabid ; it was very probably so in 789 cases. 
At the Athens Institute, 779 persons were treated from August, '94, 
to the end of '97. Two deaths were recorded (0.255^). Furthermore,, 
the treatment failed in one case where a wolf had inflicted the bite. 

Pasteur's experiments have been repeated by Ernst, who finds (i)^ 
that, in the cords and brains of animals inoculated in Pasteur's labora- 
tory, there exists a specific virus which is capable of producing similar 
symptoms through a long series of animals ; (2) that these symptoms 
are certainly produced by inoculation under the dura mater, but less 
certainly by sub-cutaneous injection ; (3) that the strength of the virus 
is lessened by placing the spinal cords containing it in a dry atmos- 
phere and at an even temperature ; (4) that the symptoms produced by 
the inoculation only appear after a period of incubation shorter whea 
the virus is inoculated by trephining than when hypodermically ; (5) 
that inoculations practiced after the manner of Pasteur, protect in a. 
marked manner against an inoculation with virus of full strength ; and 



APPENDIX TO THE MINUTES. I4I 

(6) that while heat destroys the power of the vifus, cold does not, and 
hence, the virus may be kept by freezing the cord containing it until 
needed for use. 

Von Frisch confirms some of Pasteur's conclusions, but finds that 
protection against '* street rabies," can only be obtained by sub-dural 
injection, and that healthy animals treated by the method of intensive 
inoculation may themselves become affected with rabies. He con- 
cludes, therefore, that even the possibility of protecting animals by 
inoculation is not demonstrated ; and that there is no reason to be- 
lieve that inoculation is preventive in man ; and that, on the other 
hand, there is a strong reason to believe that rabies may be caused by 
the prophylactic inoculations themselves. The accuracy and signifi- 
cance of Pasteur's observations have also been disputed by many other 
writers, among whom may be mentioned Abreu, Peter, Spitzka, 
Dulles and Ashhurst. The latter writer says, '* That it must be 
remembered that while dog bites are very common, hydrophobia is, in 
most localities, very rare. The majority of physicians go through life 
without seeing a single case of this disease. The surgeon should, 
therefore, I think, feel very certain, that the victim of a dog bite, is 
really threatened with hydrophobia, before advising a treatment, which 
is not only of doubtful efficacy, but may itself cause the disease which 
it is intended to prevent." 

The statement of these observers, I will in no wise dispute. Upon 
careful study of the results of their observations and experiments, 1 
find that they differ but little if any from those given by Pasteur. 

We must remember that these experimenters were handling poisons 
but little understood and whose potencies varied according to the 
method of using, the time they were kept before using, and the tem- 
perature in which they were kept. Their lack of knowledge and 
crudity of material used, no doubt, was the cause of producing the 
very disease intended to cure. But I can hardly subscribe to the 
statement of the last writer. To deny the existence of a disease, be- 
cause one has not had proven to him, that there is such a disease, is 
relegating oneself to a future age needing fuller development. 

With all the crudity of method, however, the Pasteur treatment has, 
in cases of hydrophobia, which were proved to be caused by the bite 
of a rabid animal, lowered the mortality from 95^ to i^, such a treat- 
ment cannot be of doubtful efficacy. 

Hydrophobia presents peculiar difficulties in the application of 



14-2 MEDICAL SOCIETY OF NEW JERSEY. 

Pasteur's method. The treatment has to be applied before the 
definite symptoms have developed in the patient. Accordingly, there 
is no certain indication in the patient himself that he has really been 
infected with the virus of rabies; the inference, that he has been so 
infected, is based on the knowledge of the condition of the dog that 
bit him, and on the extent of the injury inflicted ; but the knowledge 
of the actual state of the dog which inflicted the bite upon the person, 
who thinks that he has reason to fear an attack of hydrophobia, is 
often wanting. It is often merely feared, that the dog was mad, and 
he is shot forthwith ; so, often the only proof we have that the dog 
was rabid would be found in the development of hydrophobia in the 
man bitten by the dog. the dog itself having been destroyed. Another 
difficulty lies in the fact that the period of incubation can never be 
correctly estimated, therefore, the dose or repetition of the inocula- 
tions has to be made somewhat empirically and experimentally. 

The endeavor is to shorten the period of incubation by inoculation, 
and allow the injected virus to act before that, inflicted by the animal. 

Still another difficulty lies in the fact, that this method can be 
carried on only in institutes established for the treatment of cases of 
hydrophobia. These demand skilled operators ; transportation 
charges may be heavy, if the patient lives some distance from the 
institute ; enforced absence from home and friends, all mitigate 
against the use of this treatment. 

In his experiments, Pasteur proved beyond doubt that the poison of 
hydrophobia was most virulent in the spinal cord. He could not pro- 
duce rabies by inoculating animals with the saliva or blood of a rabid 
animal. This proves that the virus is not found in the blood, but can 
we riot say that the blood might be antitoxic. Twelve years after 
Pasteur failed to produce *' rabies " by inoculating with blood, Behring 
discovered that the blood of an animal immunized for a certain in- 
fectious disease, may be employed for protective vaccination, and even 
in larger quantity exercise a certain influence after infection has 
occurred. 

Pasteur could not produce rabies by blood injection, why cannot 
rabies be thus cured following the axiom of Behring ? So, if the 
serum of animals inoculated with the toxin poison of diphtheria will 
prevent or cure diphtheria ; if the serum of animals inoculated with 
the toxin poison of tetanus, will prevent or cure the patient suffering 
with tetanus, why is it not probable that the serum of an animal or 
the spinal cord of an animal inoculated with toxin poison of hydro- 
phobia will prevent or cure hydrophobia ? 



APPENDIX TO THE MINUTES. I43. 

The analogies between tetanus and hydrophobia and diphtheria and 
hydrophobia are striking. The convulsions of tetanus are very similar 
to those of hydrophobia. They also have symptoms fairly common 
to both. 

If diphtheria or hydrophobia have existed long enough, we have a 
condition of paralysis more or less complete. 

In diphtheria, this paralysis has been found to be due to a toxic 
neuritis, Is it too much to say that this condition of toxic neuritis 
might be also the cause of the paralysis in hydrophobia ? I think not. 

Now it is possible to produce immunity in dogs without producing 
rabies. The proof of this fact is in Pasteur's own observations. 

He inoculated some dogs with a quantity of rabid virus just small 
enough to fail in producing the disease, expecting that they would be 
protected by the treatment from the injurious effects of subsequent 
inoculation with a full dose, this he found, however, was not the case ; 
such dogs when subsequently inoculated with a full dose, developed 
rabies in the usual way. 

He also found that the virus of a dog introduced into a rabbit, and 
cultivated through a series of rabbits, increased in virulence, tie 
found after about ninety transmissions, a marked shortening of the 
incubation period and a proportionate increase of virulence in the 
spinal cord. 

Pasteur found on the other hand that the virus from a rabid dog,, 
when transmitted from individual to individual through a series of 
monkeys, gradually lost its activity, so that after passing through 
several monkeys it became incapable of producing rabies in a dog. 
Pasteur makes the very important statement that the dogs thus 
treated with the virus which had been weakened by cultivation in 
monkeys, although they did not develop any symptoms of rabies, were 
rendered refractory to subsequent inoculations with strong virus ; that 
is, were protected. Thus, these dogs were made immune precisely as 
we immunize in diphtheria. 

It now remains to mention the other treatments of which there are 
almost as many as there are individuals applying these treatments. 
There is no drug known that will act as a specific. An attempt has 
been made to neutralize the poison by administering large doses of 
mercury and to eliminate it by daphoresis. The two have been com- 
bined in the mercurial vapor bath. It has had more failures than 
successes. The Buisson treatment of hydrophobia lays much stress 



144 MEDICAL SOCIETY OF NEW JERSEY. 

«pon the effectiveness of the vapor bath. It claims to open all the 
pores of the skin, and the poisonous matter in the blood is forced out 
through the pores. This assumes that the rabid poison — the materies 
morbi — remains floating in the fluids of the body, and ignores the fact 
that the poison exerts its baneful influence primarily and essentially 
upon the nervous system. If depletion is remedial why not resort 
to phlebotomy and bleed coup-sur-coup in the good old style } No 
one claims that relieving congestion of the kidneys will repair the 
structural damage already done and cure nephritis. No more 
more can hydrophobia be cured by profuse drainage. If every drop 
of blood were removed from the body, the special system that receives 
the brunt of the disease would still remain. Hydrophobia expends its 
force mainly upon the nervous system, thus affecting the muscular. 
The theory of congestion fails to explain the effect upon the nerves. 
The supposed value of the vapor bath has from time to time been 
reaffirmed by advocates whose energy is proportionate to their 
ignorance. 

Other agents have been employed which have been designed to 
counteract not the virus but its consequences, and so to prevent or 
postpone death possibly until the malady has run its course. One of 
these is curara ; it has failed in small doses. Under larger doses 
used by injection it has succeeded in one or two cases. Hydrophobia 
seems to give remarkable tolerance to the drug, poisonous doses 
repeated of active curara having in one case been without any poison- 
ous effect. Ordinary sedatives are largely employed, the most com- 
monly used being bromide of^potassa, morphine, calabar bean, chloral, 
Indian hemp and the like. Other drugs that have been used are oil 
of tansa, gelsemium, hoangnan and atropia. Electricity has been 
used without much effect. Several cures are said to have been 
obtained from the administration of woorara, and others by the 
hypodermic use of pilocarpin and by the employment of monobromate 
of camphor. 

In all cases tranquility is of the greatest importance. The patient 
should be kept in a darkened room and all excitement or noise should 
be avoided and the friends should be excluded as much as possible. 
Nourishment is important and should be given by the rectum. Re- 
straint, if necessary, should be effectual, but as little as possible. The 
-attendants should be cautioned to have no uncovered abrasion on the 
iiands and to wash from the face or eye any saliva which might have 



APPENDIX TO THE MINUTES. I45 

been spit on them, and if they are bitten by the patient the wound 
should be treated as if it had been inflicted by a rabid animal. These 
precautions remove all danger, and any anxiety the subjects might 
feel may be relieved by the assurance that of the many persons who 
have attended on patients with hydrophobia there seems to be but 
few instances in which the disease was contracted either by attend- 
ance during life or inspection after death. 

In the preparation of this article I have, in addition to the authori- 
ties quoted, drawn very largely from the pathology and the anatomicas 
characteristics upon articles written by Gowers and Banham in 
Quain's Dictionary of Medicine. 

In conclusion, after a review of the foregoing facts the most 
rational, reliable, scientific treatment appears to be — not the inocula- 
tion of the virus itself, but of some medium containing a principal 
antitoxic of the virus of rabies. With the result of Pasteur's exper- 
iments upon monkeys before us, that animal seems to be able to 
produce such an antitoxic immune principle. The fact, however, 
operating against the practical use of this animal, is that their habi- 
tation is limited to one section of the globe. The use of the horse 
in producing the diphtheria antitoxin convinces me that this animal 
might be used to produce an antitoxin for hydrophobia. As soon 
as we can isolate the micro-organism causing hydrophobia, the pro- 
duction of antitoxin is sure to follow. Infinito fiat lux. 



\ 



ESSAY. 



BY FREDERICK RANDOLPH BAILEY, M.D. 



Hydrophobia; with Some Experimental Re- 
searches ON ITS Pathology. 

Historically, hydrophobia is one of the earliest recorded diseases. 
A disease which had so evident an etiology, so obscure a pathology, 
which followed such an unbroken course, which presented such a 
striking clinical picture, and which passed on to a fatal termination 
uninfluenced to the slightest degree by any form. of treatment, could 
not fail to draw the attention of men of science. The first mention 
of rabies, of which we have any record, is made by Aristotle in his. 
Historia Animalium, written about the middle of the third century- 
B. C. Here it is chronicled as a disease of animals, especially of dogs». 
and transmissible by biting from one to another, but not to man.. 
Xenophon, in his fifth book of the Anabasis, speaks of a disease- 
transmissible from animal to animal by biting. The first satisfactory 
recorded description of the disease, however, is that of Celcus in the 
first century B. C. He noted the fact that the disease was transmiss- 
ible by biting, not only from animal to animal, but, also, from animal 
to man, and suggested the necessity of treating all wounds or bites by 
suspected animals in the most radical manner, as by a red-hot iron or 
strong acids, in order to prevent the outbreak of hydrophobia. Galen 
and Caelius Aurelianus, who wrote in the second century A. D., 
mention the disease and give some fair descriptions. These early 
writers recognized the disease as a distinct entity, understood its 
etiology, described its symptomatology, and offered suggestions as to 
the treatment both of the wound and of the disease. This knowledge 
is considerable, and, though we find many writers describing hydro-? 
phobia during the years that follow, some fifteen centuries passed by 
without any real additional light on the subject. 

Mead, 1767, in his "Tantamen de cane rabioso," gives a more 
minute description of hydrophobia than had previously been attempted ; 



148 MEDICA!. SOCIETY OF NEW JERSEY. 

and, in 1771, Van Swieten, in his " Commentaria," reviews this descrip- 
tion, and mentions, for the first time, the paralytic form of human 
rabies. In 1802 we have originated, by Bosquillon, that idea which 
obtained such prominence later, and which is believed by some even 
at the present day, that rabies, in man. is not a real disease, but only 
the result of the action of fear upon the imagination. Another and 
rather amusing fallacy, originated by Marochetti in i82r, gained con- 
siderable credence. It was, that there always followed the biting by a 
rabid animal a small' blister situated under the tongue, the destruction 
of which would prevent the outbreak of the disease. The later years 
of the present century have witnessed the labors of Chabert, of Mey- 
nell, of Magendie, of Hertwig, of Krugelstein, of Lenhossek, of 
Virchow, and of many other investigators, who have placed our 
knowledge of the disease upon a firm and scientific basis. Last, and 
over-shadowing all, stands one dominant figure, whose name every 
mention of the disease brings to mind, and whose work in this con- 
nection, stands as one of the marvels of the century's progress in 
medicine, Louis Pasteur. But while we thus see that the beginnings of 
our knowledge of hydrophobia as a distinct disease, really antedate the 
history of medicine, our knowledge of the pathology of hydrophobia 
is of comparatively recent date. Up to the opening of the present 
century absolutely nothing was known as to the lesions accompany- 
ing the manifestations of rabies, and this can hardly be a matter of 
surprise. In studying the finer pathological changes, we are very 
largely dependent upon the use of instruments and technique, which 
were unknown to the earlier investigators. Further, the whole field 
of bacteriology and of the relation of bacteria to the infectious dis- 
eases, as well as the field of experimental pathology, were as yet 
entirely undeveloped. The very existence of hydrophobia as a distinct 
disease was doubted by a large number of students, especially in the 
later years of the eighteenth century. The opening of these new 
avenues of research in the early part of the present centurj' not only 
settled all questions as to the existence of the disease as such, but laid 
open the way towards the settling of the pathology of rabies. 

DEFINITION. Hydrophobia is a specific infectious disease caused 
by the entrance into the body and by the action upon the body tissues 
of a specific infectious substance from an animal sick with the same 
disease. The nature of this infectious substance is in all probability 
bacterial. 



APPENDIX TO THE MINUTES. I49 

BACTERIOLOGY. Pasteur was the first to make any systematic 
attempt to classify hydrophobia as one of the acute infectious dis- 
eases, and to place it upon a bacterial basis. All the known resources 
of the laboratory were exhausted in an attempt to identify and isolate 
the germ of this disease, and, while morally certain of the existence 
of such a germ, neither Pasteur nor the host of students who have 
since worked upon the subject, has been able to identify, far less to 
isolate it. 

ETIOLOGY. Always by inoculation with material from a previously 
inoculated animal. Accidentally this is regularly caused by the bite of 
a rabid animal. Both experience and experiment show that probably 
all mammals are subject to hydrophobia. Dogs, cats and wolves are 
the most common victims, and the usual source of the disease in man. 
This is not, however, because these animals are any more prone to the 
disease than many others, but because they come into frequent contact 
with one another and with man, and because they develop, co-inci- 
dentally with the attack, a desire to bite whatever they may come in 
contact with, and thus increase the opportunity for the spread of the 
disease. 

Experimental rabies is caused by taking material from a previously 
rabid animal and with it inoculating another animal. At the time 
when scepticism as to the existence of hydrophobia as a disease, and 
its explanation as a result of fright upon the imaginative faculties, 
reached their greatest prominence, various possible causes for an 
attack of rabies in an animal, other than by inoculation from a rabid 
animal, were suggested. Among these, that the virus might be found 
in the soil, and reach its victim by means of wounds on the skin or 
per OS. The same was suggested in regard to water. Excessive heat 
and undue sexual restraint were also mentioned as possible etiological 
factors. Nor was it possible to bring very strong arguments against 
these suppositions until the era of experimental pathology. At- 
tempts were then made to prove or to disprove all of the above as 
sources of origin of hydrophobia. Earth and water from possibly 
infected sources were fed to the animals, and were also rubbed into 
wounds in the skin. Even earth, into which had been rubbed the 
virus from a rabid animal failed in almost every case to reproduce the 
disease. This last probably due to the fact that the infectious mater- 
ial of hydrophobia rapidly losses its virulence when exposed to air. In 
like manner were tried artificial heat and cold and sexual restraint. 



ISO 



MEDICAL SOCIETY OF NEW JERSEY. 



Animals were incubated for various periods, even up to causing death ; 
moderate and extreme cold were also tried ; animals were kept con- 
fined in laboratories and with no opportunity to gratify the sexual 
impulse, for upwards of a year and always with negative results. 

PATHOLOGY. Since the middle of the eighteenth century and the 
writings of Mead and Van Swieten, more or less careful autopsies 
have been made upon the bodies of men and animals which have died 
of hydrophobia. These have resulted in a fairly accurate macroscopic 
pathology of the disease, the most significant point of wliich was its 
absolute failure to offer any explanation of the symptomatology. 
Before death, whether in man or in animals, the body usually becomes 
considerably emaciated, this emaciation being due on the one hand to 
the fact that little or no nourishment is taken during the attack, and 
on the other, to the enormous expenditure of energy, except in the 
paralytic form of the disease. 

The blood is apt to be dark colored and thick, and " exudes " rather 
than flows from the cut vessels. The internal organs are in a stale of 
intense congestion. At death there is added to the congestion a 
condition of acute or granular degeneration, such as is commonly 
found accompanying an infectious disease. The mucous membranes 
of the respiratory and gastro-intestinal tracts are congested and in a 
catarrhal condition. The stomach is empty of food stuffs and in the 
case of free and non-paralyzed animals is filled with foreign sub- 
stances, such as stones, wood, etc., which the rabid animal has 
snapped up. This is, of course, not of the nature of a lesion, though 
dependent on the rabidity of the animal. It is not found in animals 
confined in cages or in those suffering from the paralytic form of the 
disease. It is, however, so certain an occurrence in canines having 
accidental rabies that, taken in connection with the clinical symptoms, 
it is a valuable aid to diagnosis. Of course its absence will not en- 
tirely eliminate the possibility of hydrophobia. 

The symptoms of hydrophobia early led to the belief that their 
explanation lay in pathological changes in the nervous system. Re- 
sults of macroscopic investigations showed that the changes, though 
found, were in no way specific. The brain and cord are, like the 
other organs of the body, in a state of congestion. There is apt to be 
more or less oedema. This congestion is general throughout both 
gray and white matter. The intensity of the congestion together 
with, as will be seen later, the microscopical lesions of the vessel walls. 



APPENDIX TO THE MINUTES. 151 

often determine larger or smaller hemorrhages in the vicinity of the 
distended vessels and, probably dependent on those circulatory chan- 
ges, areas of softening, visible to the unaided eye, make their appear- 
ance, being especially prominent in the medulla and cord. 

Although the entire nervous system is more or less involved, in 
certain regions the lesion is apt to be more marked. These regions 
are the basal ganglia, the floor of the fourth ventricle, the motor 
nuclei of the medulla and the gray matter of the spinal cord. Areas 
of softening or necrosis of the cord, especially prominent in the 
anterior horn and adjacent white matter and extending also into the 
posterior columns, particularly along the border line between the 
columns of GoU and Burdach, are considered by some investigators 
as characteristic of human rabies. Also in the cortex are found simi- 
lar though less pronounced changes which, according to Benedict, 
are most marked in the region of the Sylvian fissure and in the region 
of the ol factor}' lobe. 

The microscopic pathology of rabies is, of course, of much more 
recent date than the macroscopical, and, as in the case of the latter, 
the most pronounced lesions are found in the nervous system. Much 
careful investigation has recently been carried on upon the micro- 
scopical changes accompaning rabies, and the results are briefly as 
follows : 

I. — Vascular changes. The intense congestion has already been 
referred to as one of the macroscopic changes. In sections the 
arteries and veins are both seen to be distended and filled with blood. 
The perivascular lymph channels are also distended and filled with 
escaped leucocytes. There is a decided tendency for these leucocytes 
to collect in groups, to which groups Benedict and Gowers have 
applied the term ** miliary." In some sections, according to the above 
writers, these leucocytes are seen not only to collect in the peri- 
vascular spaces, but show a decided tendency to infiltrate the adven- 
titia up to the muscular coat and more rarely to completely fill the 
vessel, apparently obliterating it and forming a thrombus. Besides 
this cellular infiltration there is sometimes a serous infiltration with 
the formation of fibrin. 

In the vessel walls various changes have been described. Kolesni- 
koff finds proliferation of the endothelial cells, of the cells of the 
muscular coat and of the adventitia elements. Pfitz and Friedeburg 
find hyalin degeneration in the vessel walls, which is also described 



152 MEDICAL SOCIETY OF NEW JERSEY. 

by Schaffer and Kolesnikolf. The latter, finding a colloid reaction in 
this hyalin material, accepted it as a derivative of the red blood cells, 
while Balzer and Benedict consider it as a white blood cell derivative. 
Among the important results of these mural changes in the vessels is 
the already alluded to weakening in their walls and the consequent 
dependence upon this factor of the perivascular infiltration and hem- 
orrhage. Benedict also describes small dilatations of the vessels of 
the nature of aneurisms as resulting from the pressure on weakened 
walls. 

Hemorrhages, both large and small, are a constant element. They 
are found in both grey and white matter, usually in the vicinity of the 
larger vessels. All of these changes of a vascular nature involve the 
pia as well as the nervous tissues. 

II. — Changes in the elements proper of the nervous system, in the 
nerve cells and processes and in the glial cells and fibres, as demon- 
strated by the more recent methods of technique, have been described 
by Schaffer, Babes, Golgi, Poppoff, Nagi, Germano, Capobianco and 
others Their investigations covered the brain and spinal cord, and 
in some cases the peripheral and sympathetic nervous systems, and 
include both man and lower animals, more especially the dog, cat and 
rabbit. 

CHANGES IN THE NERVE CELL. 

Schaffer observes a considerable variation in the lesions in differ- 
ent cases, both in man and in animals. He confirms the already 
mentioned observations of earlier writers in regard to the localization 
of the more marked changes in direct relation to the point of infec- 
tion, /. e., for anterior infections, in the cervical cord, for posterior in- 
fections, in the lumbar cord. Schaffer recognizes two distinct types 
of cell in the anterior horns : {a) Small cells whose protoplasm stains 
very darkly with aniline dyes ; {b) Large polygonal cells, the proto- 
plasm of which takes only a very faint color when stained with the 
same dyes. In both types of cell the nucleus stains more darkly than 
the cell body. 

In cells of the first type the protoplasm of the cell body appears to 
be in a condition of granular degeneration. Often small vacuoles are 
observed. Sometimes the contour of the cell is irregular. In many 
cells there is an atrophy of the cell body, of the nucleus and of some 
or all of the processes. In cells of the second type Schaffer describes 
the changes simply as a granular degeneration of the cell protoplasm 



APPENDIX TO THE MINUTES. I 53 

with fading of the nucleus. More complete stages of degeneration, 
such as are found in human rabies, Schaffer did not find in the experi- 
mental rabies of rabbits. 

About the same time Gianturco found changes similar to those 
described by Schaffer in a case of human rabies. These changes 
accorded with those found by Schaffer, both microscopically and 
macroscopically, and involved the entire length of the cord, including 
the basal ganglia. 

Babes, in 1881. confirmed the observations of previous writers as to 
the vascular changes in rabies. He also studied the nerve fibres and 
found oedema and a beginning degenerative change in the medullary 
sheaths. In 1887 he described an atrophic condition of the cells of the 
anterior horn and of the motor nuclei of the medulla. In a still later 
paper and in connection with the use of an improved technique — 
hardening in alcohol and staining with methylene blue — the same in- 
vestigator described degenerative changes in the nerve cells, and also 
confirmed the relation of the region of most pronounced changes to 
the point of inoculation. This for both man and animals. 

In their last writings both Babes and Schaffer describe the small 
perivascular collections of leucocytes as highly characteristic of rabies 
and not found in any other disease. By way of comparison, Babes 
studied the nervous tissue lesions in bulbar paralysis, in progressive 
muscular atrophy, in infantile paralysis, in acute myelitis, in tetanus 
and in eclampsia. In the last two only did he find that the lesions 
bore a general resemblance to those found in rabies, and even here 
there was an entire absence of the closely packed groups of leuco- 
cytes found just outside the blood vessels in the rabies cord. Both 
Babes and Schaffer consider these miliary groups of cells as pathog- 
nomonic of rabies, and their absence as positive proof of the non- 
existence of the disease. They are found in the early stages of the 
disease, though less prominent than at a later stage. Babes thinks 
that the extent of these perivascular infiltrations is an exact measure 
of the virulence of the infecting virus. 

The studies of Golgi upon the nerve cell changes in rabies have a 
peculiar weight, coming as they do from a man whose work has done 
more than that of any other one man towards the advance of our 
knowledge of the structure of the nervous system. These changes 
are described by him as follows : 

I. Changes in the structure of the nucleus— swelling; more or less 



154 MEDICAL SOCIETY OF NEW JERSEY. 

loss of outline; increased prominence of the chromatic elements. 
These nuclear changes in other than nerve cells he describes as resem- 
bling the changes which are associated with indirect cell division. 
They appear first in the endothelial cells lining the vessels, later in 
the cells of the neuroglia tissue, and finally in the cells of the epen- 
dyma. The changes in the nucleus of the nerve cell proper he con- 
siders of a caryolytic, /. ^., destructive character, rather than of a 
caryokinetic, /. e. constructive type. 

2. In the cell body there are changes of both form and structure 
which are constant in character and have a very wide distribution 
throughout the brain and cord. Using his own method of staining by 
means of the action of silver nitrate upon tissues hardened in solutions 
of the chrome salts, he finds in the cells of the brain and cerebellar 
cortices, of the medulla and cord, a decrease in size, with the forma- 
tion of vacuoles of blister- like appearance. Both body and processes 
show a progressive atrophy. Sometimes the processes are swollen 
instead of shrunken, and the same is true of the cell body. Golgi 
also found in the cells of the spinal ganglia, changes similar to those 
in the cord cells, the vacuolization being an especially marked feature. 
Fatty degeneration was also present in many cells. This was most 
marked in the paralytic form of the disease, and in protracted cases 
extends to the cells of the neuroglia. 

A quite different view of the nature of the pathology of rabies is 
taken by Germano and Capobianca. These investigators look upon 
the changes in the neuroglia elements as representing the primary 
lesion, and consider the changes in the nervous elements as consecu- 
tive to the changes in the connective tissue. 

Changes other than in the central nervous system have also been 
desciibed. Thus Pollaion and Nepveu, in reporting the pathology of 
a case of human rabies, note a compression and cellular infiltration of 
the Gasserian ganglion. Sampson and Clippingdale report examina- 
tions of thfe retina, by means of the ophthalmoscope, in several cases 
of experimental rabies in rabbits, and the finding of a hyperaemia of 
the retinal vessels. Falchi also examined the retina of rabbits dead 
from rabies, and observed an oedema around the papilla and degener- 
ative changes in the retinal cells. 

Next in prominence to the changes in the nervous system are 
changes in the salivary glands. This is to be expected, as the secre- 
tions of these glands contain the infectious material in large quantities. 



APPENDIX TO THE MINUTES. I 55 

The changes are of the nature of an acute parenchymatous degenera- 
tion of a pronounced type. Changes have also been described in the 
lungs, liver, kidneys and intestines. These changes are all of the 
nature of a parenchymatous degeneration. Roux and Klebs find 
*€edema and swelling of the lymph nodes and. just previous to the 
•death of the animal, a marked leucocytosis. 

The investigations which have been undertaken by the writer have 
had the following aims : 

1. A study of the finer details of the changes which take place in 
the nerve cell as a result of the action of the poison of rabies. 

2. Incidentally the corroboration or negation of the views of pre- 
vious writers as to the other changes in the nervous system due to 
rabies. The latter study, being a side rather than a main issue, does 
not claim to be an exhaustive study of these changes, but merely a 
noting of them as they chanced to come under observation during 
•the pursuit of the major investigation. 

The material used in the carrying out of these studies was as follows : 
I. — Normal rabbits and guinea-pigs. Six rabbits and about an 
equal number of guinea-pigs were first used in a series of laboratory 
•investigations, extending over about a year, in order to determine 
what might properly be considered the structure and appearance of a 
normal cell from different parts of the nervous system. As practically 
no work has been recorded upon the subject, this was a necessary 
proceeding in order to have a basis for comparison. 

The technique followed in connection with these animals was as 
follows : 

1. Animals were selected which had been for some time under ob- 
servation and which gave every evidence of being in a normal condition. 

2. They were killed (a) by chloroform, (d) by ether, (c) by bleeding. 
This for the purpose of eliminating any influence the mode of death 
might have upon the appearance of the cells. 

3. Material was fixid in (a) alcohol, (d) formalin, (c) corrosive sub- 
limate in various strengths and as Lang's fluid, (^) Van Gehuchten's 
fluid — alcohol 60, chloroform 30, acid acetic 10. This to determine 
the various effects of different fixing fluids upon the appearance of 
the nerve cell. 

4. Staining by various modifications of the method of Nissl. 

II. — Six rabbits which had been subjected to inoculations with the 
virus of rabies. The injections of the virus were subdural and were 



156 MEDICAL SOCIETY OF NEW JERSEY. 

made between the occiput and the first cervical vertebra. Of the six 
rabbits, the first three in the series were killed by chloroform. Of 
these three, the first was killed between the second and third day 
after inoculation, and had shown no symptoms of rabies. The second 
was killed oh the first appearance of symptoms; no paralysis, but 
the animal simply seemed sick. This was on the fifth day after inocu- 
lation. The third rabbit was killed on the sixth day, after having 
shown partial paralysis for about thirly-six hours. 

It will be noted from a comparison of the last two rabbits that the 
animals differ somewhat as regards their individual susceptibility to 
the virus, and this despite the fact that animals of approximately the 
same size, weight and condition of health were selected. Thus the 
second rabbit in the series was killed on the first appearance of symp- 
toms on the fifth day after inoculation, while the rabbit killed on the 
sixth day had been partially paralyzed for thirty-six hours. The same 
variations in susceptibility are seen in the following : The three re- 
maining rabbits were allowed to die, the deaths taking place on the 
sixth, seventh and eighth days after inoculation. Of these, the one 
dying on the sixth day differed from the other two in showing a much 
greater activity and less marked paralysis. The rabbit dying on the 
seventh day had had symptoms for about three days, and the death 
on the eighth day occurred four days after the initial symptoms. In 
the last two the paralysis before death was almost complete. 

III.— For comparison, (a) Four guinea-pigs inoculated with diph- 
theria toxin. One killed before any symptoms, one about the third 
day and the other two dying one on the fourth day and one on the 
fifth day. 

{d) Two rabbits inoculated with rattlesnake poison. One received 
a large dose and died in about fifty minutes ; the other received con- 
secutive small doses and died in about four days. 

(c) One rabbit dead from the poison of a heloderma. 

{d) h case of acute alcoholism. 

{e) A case of peripheral neuritis. 

Technique : The animals were killed by chloroform. 

1. Fixation : Van Gehuchten's fluid or formalin, 5 per cent. 

2. Preservation : Alcohol, 97 per cent. 

3. Embedding: Celloidin. 

4. Staining : Sections are first stained in erythrosin, one per cent, 
aquous solution with heat, until the fluid began to steam ; washed in 



APPENDIX TO THE MINUTES. 1$? 

water ; transferred to a one per cent, solution of methylene blue to 
which a small amount of acetone had been added. In this fluid the 
sections are warmed until the odor of acetone ceases to be given off. 

5. Decolorization in alcohol ; cleared in xylol and oil of cajeput ; 
mounted in xylol damar. 

Subjected to the above technique, the cell of the central nervous 
system in rabbits and guinea-pigs — taking one of the large anterior 
horn cells as an example — presents the following structure : 

1. A nucleolus which stains an intense blue. 

2. A nuclear membrane which takes a red stain and is rather in- 
distinct, the outline of the nucleus being largely emphasized by the 
arrangement of the chromatic bodies around its periphery. 

3. A clear nuclear basement substance which takes neither stain. 

4. Extending throughout this basement substance, connected on 
the one hand with the nucleolus and on the other hand with the 
nuclear membrane, a fine meshed reticulum which takes a bright red 
stain. 

5. In the cell body, first a clear basement substance which remains 
unstained. 

6. A cyto-reticulum, staining red, which extends as a fine meshed 
network throughout the cell body, as elongated meshes into the vari- 
ous protoplasmic processes and as a fibrillar structure into the axis 
cylinder process, to be continued as the ultimate fibrils of the nerve 
fibre. 

7. Scattered throughout the cell body and bearing no apparent rela- 
tion to the other elements, various shaped bodies which, on account 
of the intensity of their affinity for certain dyes, are known as chromo- 
philic bodies. These take the methylene blue stain. »- 

The same general structure was noted in all cells studied, whether 
in brain, cord or spinal ganglia, the differences being such as variations 
in the relative size of nucleus and cell body, in the coarseness of the 
network mesh, and in the arrangement and size of the chromophilic 
bodies. In like manner the pathological changes observed in the 
cells of different parts of the central nervous system in the rabies 
rabbits seem to be of an essentially identical nature, and as their 
demonstration is much more easy in such large cells, as those of the 
anterior horn, the description of these changes will be confined to 
these cells. 

In the series of experimental rabies in rabbits : 



158 MEDICAL SOCIETY OF NEW JERSEY. 

I. The lesion of the nerve cell. The earliest observable changes^ 
apparently begin coincidently in the nucleus and in the cell body. 
The nucleus first becomes swollen and rather larger than in the nor- 
mal cell. This seems to cause a condensation at the periphery of the 
nucleus and its contour appears more sharply defined. Whether for 
the same reason or for some other, there is also an increase in the 
clearness of the strands of the intra-nuclear network. There is no 
change in the form of the nucleus. It remains round and its central 
position in the cell remains unchanged. In the cell body the earliest 
changes are noted in the masses of blue material known as chromo- 
philic bodies. These bodies, which in the normal cell appear quite 
compact and, while irregular, fairly smooth in outline, become ragged 
and their edges begin to present a rather feathery appearance. The 
writer has as yet been unable to determine which of the above 
changes take precedence in point of time, those in the nucleus or those 
in the cell body. Sometimes the nerve cell appears normal in size ;, 
sometimes it shrinks away from the surrounding tissues to a slight 
extent, leaving an exaggerated peri-cellular lymph space. Again, the 
cell may be slightly swollen. With these slight changes in the 
chromophilic bodies, the basement substance remains clear. Animals- 
killed very soon after inoculation, before the onset of the symptoms, 
show a considerable number of cells is this stage of degeneration. 

The continuation of the changes in the nucleus is as follows : After 
the initial swelling and increase in distinctness of both its outline and 
of the intra-nuclear network, an opposite condition begins. There is. 
a beginning shrinkage of the nucleus at first uniform, the nucleus 
preserving its round shape. The nucleo-reticulum becomes less dis- 
tinct and the basement substance or nucleo-plasm, instead of remain- 
ing perfectly clear, shows more or less tendency to retain some color. 
This color is usually of a light pink shade, and on closer analysis fine 
reddish granules are seen scattered through it. My own explanation 
of this appearance, which gives to the nucleus a rather blurred look, 
is that the beginning disintegration of the nucleo-reticulum sets free 
these minute granules which, floating free in the nucleo-plasm and 
taking the same stain as when a part of the reticulum, give to the 
nucleus a general pinkish color. As further progress of the nuclear 
changes goes on the shrinkage becomes more marked, the previously 
spherical outline is lost and the nucleus takes on an at first irregular 
and later a quite crenated aspect. Portions of the nuclear membrane- 



APPENDIX TO THE MINUTES. 1 59 

next disintegrate, leaving the outline of the nucleus incomplete, and 
finally the nuclear membrane entirely disappears and there is neither 
dividing line between the nucleus and the cell body nor is there any 
apparent differation in their structure. During all these changes the 
nucleolus remains unaltered. Mysterious in its structure and func- 
tion it maintains the mystery in taking no apparent part in the degen- 
erative changes of the cell. Ultimately it disintegrates and disappears,, 
often, just before the end, assuming a crenate form, but this is always 
one of the latest of the phenomena of cell degeneration. Indeed, I 
have observed the nucleoli remaining from degenerated and destroyed 
Purkinje cells, making a line just outside the layer of granular cells, 
after almost all traces of the cells which had contained them had 
disappeared. 

The continuation of the changes in the cell body is as follows: 
From the condition already described, in which the chromophilic 
bodies have a more feathery outline than in the normal cell, the pro- 
gress of the degenerative process is continuous. They present an 
ever increasing roughness of outline which passes on to a breaking 
up of the masses into larger or smaller pieces. Up to this point the 
cyto-plasm has remained quite clear. This dividing of the chromo- 
philic bodies is next succeeded by a condition of actual disintegration 
in which some of the chromatin, instead of being confined in the 
bodies themselves, is scattered through the cyto-plasm, apparently iiv 
solution, or more probably in a state of minute subdivision. As it 
preserves its staining properties it gives to the entire cell a diffuse 
blue color. Up to a certain point there seems^to be no actual loss of 
chromatic substance and the total blueness of the cell remains un- 
diminished. As the degeneration goes on, however, there is a positive 
loss of this substance and a consequent gradual decrease in intensity 
of color. Ultimately the chromatin entirely disappears and the ceU 
body becomes entirely clear and unstained. 

2, The cyto-reticulum. Throughout the earlier changes in the ceU 
body and up to the point where the disintegration of the chromophilic 
bodies and the appearance of diffuse chromatin in the cyto-plasm has- 
become quite pronounced, the cyto-reticulum remains apparently 
unchanged. As the chromatic ^masses become less and the diffuse 
blue stain becomes darker, the reticulum seems to be gradually lost 
or covered up in the intensity of the general stain. And when its 
reappearance might be expected after the clearing up of the cyto- 



l60 MEDICAL SOCIETY OF KEW JERSEY. 

plasm, its reticular mesh has vanished and is represented only by fine 
pinkish granules throughout the cyto-plasm. 

3. The cyto-plasm. Possible changes in the cyto-plasm are un- 
demonstratable, owing to lack of staining qualities. Its only apparent 
modification is through the already mentioned acquisition of chromatin. 

4. Changes in shape and size of cell body. Concurrent with these 
changes in the structure of the nucleus and of the cell body, are 
changes in the form of the outline and size of the cell. The initial 
swelling is replaced by contraction, at first more or less uniform, 
preserving the original shape of the cell. Later, as is the case with 
the nucleus, the contour becomes irregular, giving the cell a kind of 
" eaten out " appearance. The cell processes share both in the initial 
swelling and the subsequent shrinkage. They become more distinct 
and more darkly stained, seemingly due to a condensation dependent 
upon contraction. 

CHANGES IN ELEMENTS OTHER THAN NERVE CELLS. 

The vascular changes of hydrophobia. My own observations 
coincide in general with the descriptions given by tlfe majority of 
investigators and lead me to believe that an intense conjestion is the 
earliest lesion. Preceding, as it does, the changes in the vessel walls, 
the latter appear very thin, often barely visible. 

In regard to the changes of the vessels. I have not been able to 
make out the proliferative changes in the endothelial and muscular 
coats, as described by Kolesnikofl. The entire change in the walls 
of the blood vessels seems to me to consist in a production of new 
connective tissue from the connective tissue cells normally found there. 
This productive inflammation involves primarily the outer coat but 
usually extends in among the muscle walls. 

I have also failed to observe any such definite perivascular group- 
ings of leucocytes as to be able to consider their appearance as 
pathognomonic. There is a general infiltration of the walls with 
small round cells, and this infiltration is irregular, thus presenting in 
cross section somewhat the appearance of definite groups. Certainly 
in one other disease there is a very similar, if not identical, condition, 
that is in Landry's paralysis. 

The neuroglia connective tissue, like the connective tissue of the 
blood vessels, undergoes a hyperplasia which is of the nature of an 
acute productive infiammation. These opposite conditions — that of 



APPENDIX TO THE MINUTES. l6l 

regeneration in the connective tissue elements and of degeneration in 
the nerve cell elements — explains the description of Golgi, of the 
caryolitic condition of the nerve cell nuclei in and the caryokinetic 
condition in the nuclei of the connective tissue. 



11 



appendix to the minutes. 1 63 

Report on the Progress of Surgery, 
by charles young. m.d., newark, n. j. 

Abolition of sensation by means of intraspinous injec- 
tions. — In May last. Professor Tuffier, of Paris, published a report of 
a series of operations, performed by him, on patients in whom sensa- 
tion had been suspended by the injection of a solution of cocaine into 
the spinal canal, the patients meanwhile retaining perfect conscious- 
ness. In from four to ten minutes after the introduction of the 
solution, there is perfect and complete abolition of sensation through- 
out the entire system, with slight diminution of the motor powers, but 
with not the slightest effect upon consciousness. At the time of the 
publication of the monograph, he had operated upon 63 cases. Since 
then he has operated upon 107 cases while sensation was suspended 
by cocaine injections. The operations have covered the domain of 
Surgery, including gastrotomy, radical cure of hernia, abdominal hys- 
terectomy, and other operations of like gravity, as well as minor 
operations in which, for various reasons, general anaesthesia was con- 
traindica^ed. Tuffier uses a long platinum needle with a syringe- 
larger than the ordinary hypodermic syringe. He uses a 2 per cent- 
solution of cocaine, and insists that the solution be made sterile, and 
that it be freshly prepared. The dose should never exceed 2 cgm ; 
usually 1.5 cgm. is sufficient. Perfect insensibility to pain continues 
from one and one-half to two hours after the injection is made. Nausea 
is a frequent consequence.' The pupils are dilated, the pulse-rate 
slightly increased. It has been suggested that Eucaine B would be 
preferable, since it is less readily decomposed by sterilization. Profes- 
sor Tuffier has had no accident in his experiments. The ages of the 
patients have ranged between twelve and sixty-three years. He con- 
'siders it unsafe to make the injections in very young children. 

Local anaesthesia in the radical cure of hernia. (^«- 
nals of Surgery, ]2Xi\x^xy, 1900.) Gushing reports that 233 herniot- 
omies have been performed in Halsted's clinic at Johns Hopkins Hos- 
pital during the last two years, and that in 49 of these local anaesthesia 
alone was used. In the cases reported, general anaesthesia was con- 
traindicated in consequence of advanced age, chronic bronchitis, and 
emphysema ; tuberculosis, laryngeal and pulmonary ; marked cardio- 
vascular changes, chronic nephritis; and above all, the shock and 



164 MEDICAL SOCtETY OF NEW JERSEY. 

vomiting in strangulation. Besides these there were about two hun- 
operations of major character, where the use of a general anaesthetic 
was avoided for similar reasons ; thirty laparotomies, two gastrotomies, 
closure of traumatic rupture of jejunum ; three cholecystotomies for 
empyema of gall bladder ; three appendectomies, and one operation 
for typhoid perforation. Gushing says that it is extraordinary that 
handling, resecting and suturing the gut should be unattended by 
pain. Cocainization of the gut has never been necessary. An attempt 
to drag upon the gut does cause some pain. Amputation of the 
appendix has always been painless. Local anaesthesia is particularly 
suitable for the ligation of varicose veins, suprapubic cystotomies, 
and all scrotal operations, if done through the high incision. Dr. 
Gushing has carefully studied the distribution of the cutaneous nerve 
supply of the operative area of hernia. Such knowledge is essential 
to the proper employment of local anaesthesia. (It would appear that in 
all major operations Tuffier's method would be preferable. Unless 
reports exaggerate, its possibilities of usefulness are nearly limitless) . 
Treatment of surgical tuberculosis with formalin- 
glycerin injections.— in Centralb. f. Chirurg., 1899, vol. xxiv, 
p. 689, Johannes Hain (Vlainz) contributes an article on this subject. 
Two years ago he began the formalin injections. He used a freshly 
prepared solution (35 per cent. Formaldehyde). The most suitable 
field for the injections seems to be cases of tuberculous joint disease, 
which have gone on to suppuration, but in which the soft parts are 
not yet extensively involved. Formalin injections are also adapted to 
cases of tuberculous empyema. The most convenient mixture is 
made by adding i to 5 cc. of formalin to 100 cc. of glycerine. Those 
joints, access to the entire surface of which is easy, respond better 
to treatment. These are hip-joint, knee-joint, and carsal and carbai 
joints. In a case of spondylitis the disease was quickly cured with 
the addition of plaster of Paris jacket. An aspirating syringe of the 
capacity of 20 cc, and capable of sterilization, is used. The needle is 
introduced into abscess cavity, and cavity emptied. Gavity is cleansed, 
if possible, without causing hemorrhage, by repeated injections and 
aspirations of a solution of boric acid. A quantity of i per cent, solution 
of formalin-glycerine equal to one-third to one-half the quantity of pus 
evacuated is then injected. Parts are kept quiet. More or less violent 
reaction takes place, size of abscess cavity increases considerably. 
This subsides in a few days. A second injection may be made at the 



APPENDIX TO THE MINUTES. 165 

end of two weeks. Recovery takes place quickly. Hain believes this 
method is superior to all other similar plans, and advocates the trial of it 
before resorting to more severe measures. He reports one case as typi- 
cal of those treated : A child, three and one-half years, seen February i, 
1897. There had been pain in left leg for six weeks. Child was unable 
to walk without limping and pain. Hip joint soon appeared swolfen and 
there was intense pain on movement of linjb. April 23, 1897, an 
exploratory puncture revealed thin, flocculent pus. All of this fluid 
(50 cc.) was evacuated, the abscess cavity cleaned with a 2 per cent, 
boric acid solution, and 15CC. of formalin-glycerin solution injected. 
Plaster of Paris cast was applied June 3, 1897; extension apparatus 
was applied July 9 ; plaster of Paris ** trousers " were applied in addi- 
tion to extension, August 23. Child was allowed to walk, still wearing 
the plaster of Paris. This was removed November 12. Skiographs 
demonstrated that there was very little deformity present in joint. 
Plaster was soon left off permanently. Patient could walk without 
pain, and had free motion of joint in all directions. There are now no 
symptoms referable to hip-joint. 

Paget's Disease.— In Brit, Med, Journal, June 16, 1900, A. 
Marmaduke Shield relates a case in which a married woman, 36, pre- 
sented redness and irritation about the left nipple. Area affected was 
trivial. It had existed for six months. The Dermatological Society 
agreed with him that it was a case of Paget's disease. So-called 
psorosperms were found in scrapings. Whole breast was removed 
with pectoral fascia and large area of skin. Axillary glands were not 
removed. Microscopically there was found no evidence of cancer of 
breast. Eight months after, a hard lump appeared in sternal end of 
scar. It was excised and proved to be a spheroidal celled carcinoma. 

Surgical sequelae of influenza.— Franke {Archir F. Kim, 
Chirwg. 1 899, Band lix) finds that involvement of the bones is a not 
infrequent sequel of influenza. Manifestations are very similar to those 
following typhoid fever. They are chiefly osteo-periostilic in form, 
with fewer cases of osteo myelitis. This is the great difference from 
other infectious forms of bone disease, as the majority of them are 
forms of osteo myelitis. Suppuration takes place in a very small pro- 
portion of cases. In his own cases, necrosis never took place, or at 
least, not the formation of sequestra. In some cases there was no 
suppuration ; in one the bone was softened. The causation of all 
these bone diseases is possibly not proved ; but it is certain that the 



1 66 MEDICAL SOCIETY OF NEW JERSEY. 

influenza bacillus, or the toxins it produces, are responsible for some 
of them. This infection is less severe than that produced by the 
streptococcus or staphylococcus, and is more prolonged in its devel- 
opment. The bacillus can apparently remain dormant for a consider- 
able period before manifesting its presence in these sequelae. 

Craniectomy. — Brit. Med. Journal, June 30, 1900. Charles 
Ward, F. R. C. S. I., Natal, reports a case of great thickening of 
skull, deafness, hazy cornea, complete loss of speech, accompanied by 
maniacal attacks, greatly relieved by Lannelongue's craniectomy. 

Laminectomy. -Meeting Amer. Med. Asso. Samuel Lloyd re- 
ports cases of laminectomy for disease and injury. In case of 
fracture there is no hope if cord is destroyed by pulpification. Obliter- 
ation of reflexes generally contraindicates operation. Operation 
should be delayed until shock passes off, and then only if there be 
probability that cord is not completely destroyed ; if there is improve- 
ment at first and symptoms become worse later ; if hemorrhage 
is producing extension of symptoms ; or if there is full re- 
covery with paraphlegia and symptoms developing later, probably 
from formation of callus. Mortality of operations is now about 50 
per cent, but we should give the patient a chance by operating. 
Dawborn, of New York, emphasized importance of early operation. 
Lloyd insisted that we should not cease removing bone until cord 
pulsates. If dura is cyanotic from presence of blood, it should be 
opened and evacuated. Dawborn says that these cases are in the 
same category as fractures of the skull, and we should not delay 
operation. 

Treatment of injuries of spinal coRD.^Anna/s of Surgery, 
August, 1899. Percival E. Bolton, New York, concludes an article on 
this subject as follows: '*Thus it appears that (i) Extradural hem- 
orrhage does not give rise to cord lesions or symptoms, and requires 
no treatment; (2) Total lesions of the cord are irremediable, because 
the cells and fibres of the entire thickness of the cord are destroyed, 
are never regenerated, and are replaced by cicatricial tissue. The 
lesion then is permanent and requires ho treatment. (3) In haemat- 
omyelia the clot is absorbed, its site persists as a cavity, or is filled by 
newly formed tissue ; irregularities of circulation in the surrounding 
portions of the cord adjust themselves. There may be great ameliora- 
tion of the symptoms. There is therefore no therapeutic indication, 
and no remedial treatment is possible. (4) In partial contusion of the 



APPENDIX TO THE MINUTES. 167 

cord, the lesion results in permanent destruction of cells and fibres ; 
disturbances of circulation adjust themselves. Repair is accomplished 
by cicatricial tissue. No treatment is available. (5) In open injuries 
of the cord there are destruction of cells and fibres, and disturbances 
of circulation. In addition, infection may occur or a foreign body be 
introduced and left in or lodged against the cord, and by its continued 
presence produce great disturbance of circulation and consequent 
extensive degeneration and necrosis of cells and fibres. Repair occurs 
by cicatricial tissue as before. But here active interference is indicated 
to remove foreign bodies, to facilitate disinfection, to prevent more 
extensive necrosis, and facilitate drainage. 

Tetanus. — In Annals of Surgery, March, 1900, Robert Abbe, of 
New York, in concluding an article incorporating nine cases of tetanus 
seen by him within two years, and treated by intracerebral and subcu- 
taneous administration of tetanic antitoxin, says : " This limited 
experience leads me to regard it as a valuable adjunct to the scientific 
treatment of this grave malady ; and I cannot but regard the cerebral 
injection as an advance over the subcutaneous method, and worthy of 
extended trial and further study." 

Trephining for epilepsy.— ^««<?/y of Surgery, May, 1900, 
quotes from the proceedings of the twenty-eighth Congress of Ger- 
man Surgeons. Professor Kocher, Berne, since 1880, has had eight 
positive cures in operating for epilepsy. Observations have confirmed 
the line of treatment directed principally to removal of exciting cause; 
removal of pressure, relief of adhesions, evacuation of abscesses. In 
these there were 68 per cent, cures. The results in cases involving 
incision of dura, and removing bony fragments, or of cicatrices im- 
pinging on brain are still better, 88.8 and 85.7 cures. Removal of 
cysts is less successful, 4.78 cures. If we accept the influences of 
fragments of bone, cysts and cicatrices as causes of epilepsy, in that 
their alleviation results in a cure, we also find by comparison of two 
further classes of operations, that there exists another and equally 
plausible origin of epileptic seizures, which is not generally recog- 
nized, that is, local and general increase of pressure. 

Results of trephining with or without incision or excision of dura 
show the following results : Dura not opened, only 14.2 per cent, 
curfes; opening of dura, 54.7 cures. It is most probable that to this 
very opening of the dura is due the favorable results in cortical 
excision. Support of this belief may be found in the fact that while 
removal of obvious source of irritation is followed by relief immediate- 



1 68 MEDICAL SOCIETY OF NEW JERSEY. 

ly, or very soon after, cortical excision, the convulsions remain rela- 
tively very severe, or are sometimes increased. Trephining with 
opening of the dura produces a permanent lowering of pressure 
throughout the whole of the cranium. Opening of the dura is essentially 
establishing a valve, whose function it is quickly to equalize variations 
of pressure. In the author's cured cases a valve has formed, which 
has become permanent, the covering membrane remaining free, and 
sinking or bulging with the lowering or increase of intracranial 
pressure. While in the unsuccessful, or recurrent cases, the communi- 
cating aperture is closed, for the greater part or entirely, either by 
long deposit, or by a cicatricial mass so dense as to render it unyielding. 
Simple fractures of skull give rise relatively frequently to epilepsy, 
but in eighteen operations for extensive fractures, in only one did epilepsy 
result. Finally, it may be laid down as a principle that increased 
intracranial pressure furnishes an explanation of that unknown quantity 
which has been called status epilepticus, 

CholeCYSTOMV. — Brit, Med. Journal, May 19, 1900. In discus- 
sion before the Clinical Society of London, Bland Sutton said that he 
was unaccustomed to suture the duct in operation. The flow of bile 
ceased after three or four days. 

Pylorectomy.— ^r/V. Med, Journal, June 2, 1900. Alfred Barker 
reports before the Clinical Society of London, a case in which he per- 
formed gastro-enterostomy in a case of carcinoma of the pylorus. At 
a subsequent operation he performed a pylorectomy. The discussion 
which followed approved of the procedure in two operations. 

Gastric \5\.C^^,—PhiL Med, Journal, M. T. Finney, Baltimore, 
states that among twenty-five patients treated in Johns Hopkins Hos- 
pital for gastric ulcer, perforation had occurred in one case only. 

Rupture of common bile dvct,— Annals of Surgery, Feb- 
ruary, 1900. Garrett reports a case of rupture of common bile duct. 
Patient was struck in falling on the abdomen. Shock followed ; much 
pain on right side of the abdomen, between ninth cartilage and um- 
bilicus. On the second day there was tympanitis, then dullness and 
collection of fluid. On the eleventh day six quarts of yellowish fluid 
were removed by aspiration. Patient was slightly jaundiced. Four 
days after, four quarts more, and again on the eighteenth day. On 
the twentieth day laparotomy was performed. There was profuse 
discharge of bile from foramen of Winslow. Rent could not be 
exposed. Abdomen was shut off and packed with gauze. Patient 
recovered. 



APPENDIX TO THE MINUTES. 169 

Diseases simulating appendicitis.— In the Mtd, Record, 
May 2'6, 1900. Dr. Edwaicl G. Janeway writes on some conditions 
which he has known to simulate appendicitis. In two cases of ncu- 
ralgia« affecting the lower abdominal nerves on right side, an operation 
was performed, but appendix was not removed. In one there were 
several antecedent attacks. Sometimes neuralgic pains are reflected 
over lower right abdomen when there is disease of an inflammatory 
nature above, more especially, pneumonia and pleurisy of right lung. 
Sometimes a pleurisy may have intervened on an appendicitis. 
Another source of difficulty is afforded by conditions of the right 
kidney, e. g. renal colic, if somewhat protracted and associated with 
fever. A swelling occasioned by a small hydronephrosis with some 
tension of the abdominal muscles, may occasion considerable difficulty. 
Hydronephrosis, with a displaced right kidney existed in one case. 
Movable kidney has been mistaken for a peri-appendicular inflamma- 
tion. Cholecystities has been operated for peri-appendicular inflamma- 
tion. The perforations of ulcers, duodenal, etc., following gastric 
inflammations; gastro-intestinal catarrh with colic coming from some 
irritant, have been mistaken for appendicitis. Tuberculous ulcers 
about the caecum, and cancer of the caecum, have occasioned great 
difficulty. A narrowing or ulceration of the hepatic flexure of the 
colon, which is apt to be attended from time to lime by accumulation 
of feces in the coecum and ascending colon, and also by movable right 
kidney. Typhoid fever has frequently occasioned difficulty, especially 
in the early stage of the disease. Sometimes they occur together. 
The history of the invasion, the condition of the spleen, the condition 
of the bowels, the presence or absence of rose-spots, Widal's reaction, 
a count of the leucocytes, will generally lead to a correct diagnosis. 
The aches and pains of acute tonsilitis, especially when marked in the 
iliac region, have led to mistakes in diagnosis. Abscess of the ovary, 
retained menstrual fluid, giving rise to sapraemia and causing fever 
and chill and pain on the right side of the abdomen. In one case 
there was a history of two weeks* sickness, following menstruation, a 
sense of soreness deep in the right side of the abdomen, more in the 
pelvis ; no exudate nor distinct swelling, number of leucocytes not 
increased, next day a free discharge of offensive. fluid from the vagina 
was followed by a disappearance of all the symptoms. 

Acute pekitoneal effusion as a symptom of intestinal 
strangulation.— 0«/r<?/^. fur Chirurg., 1899, vol. xxiii, p. 665, by 
Professor Carl Bayer (Prague). In 1898 the author had called atten- 



«70 MEDICAL SOCIETY OF NEW JERSEY. 

tion to the occurrence of acute peritoneal effusion in cases of intestinal 
strangulation, and the value of this sign in the differential diagnosis 
between strangulation and peritonitis. Heinrich Braun had previously 
remarked on this fact, in 189 1. He said fluid was analogous to fluid 
in hernial sac. Bayer writes to emphasize two points : first, the 
sympton not only indicated strangulation after having excluded peri- 
tonitis, but is a valuable aid in differential diagnosis between peritonitis 
and strangulation, and is direct proof of the latter condition. Peri- 
tonitis may be present and increasing, and the evident dullness may 
be concealed by the increasing distension of the well-known paralytic 
character. Should marked increase in dullness arise, becoming more 
marked hour by hour, and clearly shown by percussion, it indicates the 
supervention of internal strangulation on the existing peritonitis. If the 
case is a recent one, the large amount and the rapid increase of the effu- 
sion render the diagnosis one of strangulation. The second point to be 
emphasized is the importance of the acute nature of the effusion. The 
very acuteness is of aid in forming a diagnosis. In a case mentioned 
the patient had had a perityphlitis in 1897. He was admitted to the 
hospital April i, 1899. Recent trouble was subacute. There was 
slight dullness on right side. All the symptoms gradually diminished, 
and the patient began to eat food. On April 18, after a restless night, 
he vomited and complained of pain. Examination revealed a new area 
of dullness upon the left side, extending to rectus muscle. Upper por- 
tion of abdomen was distended and painful on slight pressure. Slight 
peristaltic movements were observed. A diagnosis of strangulation of 
small intestine was made. Immediate laparotomy was performed. As 
soon as peritoneal cavity was opened a quantity of bloody serum 
escaped. Small intestines were occluded by band of omentum. 

As regards the most favorable time for OPERATION IN GASTRIC 
ULCER, Lund's statistics are conclusive. In 45 cases operated on within 
twelve hours after perforation, 35 recovered ; a mortality of 22 per 
cent. Of 70 cases operated upon within twenty-four hours, 44 re- 
covered ; a mortality of 37 per cent. In a like series of cases collected 

by the same author, 14 were operated upon within twelve hours, with 

» 

12 recoveries, a mortality of 14 per cent.; and 26 within 24 hours, with 
19 recoveries, a mortality of 17 per cent. (Quoted from Annals of 
Surgery, April, 1900). 

Cirrhosis of the liver cured by Peritoneal anastom- 
osis. — In the April number of Annals of Surgery, Dr. F. Tilden 
Brown reports a case of cirrhotic ascites. The patient had been a 



APPENDIX TO THE MINUTES. I7I 

number of times a patient in the Presbyterian Hospital, New York, 
for a steadily progressing cirrhosis of the liver. He was treated by 
paracentesis. The total quantity of fluid withdrawn in seven weeks 
was 2,866 ounces. On September i the abdomen measured forty-one 
inches at the umbilicus. The patient was operated on the following 
•day. A five-inch incision was made between the ensiform cartilage 
and the umbilicus, and a two-inch incision above the symphisis. The 
omentum was found to be small, shrivelled and lumpy. The veins 
were large and tense. The lower margin of the omentum reached to 
the umbilicus, where it was adherent to parietal peritoneum. The 
round ligament was the size of the finger and hard. The liver was 
hard and small. On its surface were the characteristic hobnail lesions. 
The spleen was much enlarged. The convexities of the liver and 
spleen, as well as the peritoneal surfaces opposed to them, were 
vigorously rubbed with dry gauze in metal holders. The parietal 
peritoneum fronting the omentum was treated in the same way before 
suturing these tunics with chromicized catgut. There was but one 
transverse line of eight to ten sutures. The upper abdomen was closed 
in the usual way. Through the lower wound a glass tube, one and 
one-fourth inches in diameter, was inserted into the pelvis behind the 
bladder. Capillary drainage was provided for by gauze introduced 
within the tube. The large gauze and cotton dressings were fre- 
quently changed, and bed was wet from serum flow. Compression of 
upper abdomen by strips of plaster was kept up for three months. 
On thirty-eighth day drainage tube was removed. November i both 
wounds had closed. Abdomen measured thirty-two inches. Urine 
contains neither albumen nor casts. 

Appendicitis —Amer. Journal Med. Sciences, December, 1899. 
Maurice H. Richardson, of Boston, contributes a very able paper. He 
presents the following brief : 

I. Should every case be operated upon as soon as the diagnosis is 
made } 

As a rule, the appendix should be removed, if the diagnosis is made 
in the first hours of the attack. 

After the early hours the operation is advisable : 

1. If the symptoms are severe, and especially, if increasing in 
severity. 

2. If symptoms, after a marked improvement, recur. 

3. If symptoms, though moderate, do not improve. 



172 MEDICAL SOCIETY OF NEW JERSEY. 

The wisdom of operation is questionable : 

1. In severe cases.-^in which an extensive peritonitis is successfully 
localized and patient improving. 

2. In cases which are at a critical stage and which cannot undergo 
the slightest shock. 

II. Should the appendix be removed in every case ? 
It should not be removed : 

1. In localized abscesses with firm walls. 

2. When patient's strength does not permit prolonged search. 

It should be removed whenever the peritoneal cavity is opened^ 
unless the patient's condition forbids. 

The appendix should be removed in all cases as soon as the in- 
flammatory process has had time completely to subside, in from two 
to three months after the attack. In cases simply drained the scar tis- 
sue should be excised, the appendix removed, and the wound securely 
sutured. 

When seen very early, that is, within the first twenty-four hours ,- 
If the diagnosis is made at this time, with pain, vomiting, tenderness, 
abdominal rigidity and fever, the gravest crisis may be at hand ; the 
prognosis after the operation would be better than it would be a day 
or two later, when perhaps a general infection has taken place. The 
rule should be to intervene. A positive diagnosis at this time cannot 
always be made. The symptoms of a great variety of acute abdominal 
lesions begin in precisely the same way. Perforation of the stomach, 
acute cholecystitis, acute pancreatitis, mesenteric thrombosis and em- 
bolism, extravasation from the intestines, acute salpingitis, ovarian 
tumor with twisted pedicle, rupture of abscess, acute intestinal obstruc- 
tion, ruptured extra uterine pregnancy, all present symptoms that 
may suggest acute appendicitis. And so acute intestinal disturbances 
dependent upon errors in diet, acute gastric and intestinal catarrhs, 
ptomaine poisoning, cholera morbus, or even lead colics. As a 
rule operation is advisable as soon as diagnosis is made. In cases 
mentioned above, exploration is demanded even if diagnosis of appen- 
dicitis be not made, because the symptoms demand intervention of 
themselves, whether an exact diagnosis be made or not. On the 
other hand, it is questionable whether we should open the abdomen 
on the onset of an appendicitis of a mild type, even if diagnosis be 
reasonably clear. To this category belong the cases in which there is 
pain without nausea, vomiting, rigidity or fever, appendicular colics 
rather than true infections. 



APPENDIX TO THK MINUTES. 173 

Umbilical Hernia. — {Centralb, /. Chtrurg,, 1900, No. 2) 
Amer,Jour. Med. Sciences. Picolli calls attention to a new and 
simple method of radical operation for this form of hernia, which is, in 
a measure similar to Bassini's operation. It is based on the principle 
of replacing the linea alba by two overlapping layers of the muscular 
wall, thus transforming a linear scar, having an antero-posterior 
direction, into a transverse, broad scar, between the two overlapping 
surfaces, which is also a transverse plane to the line of pressure. 
Hernia is reduced, sac fastened with a Billroth's clamp, resected and 
sutured. Peritoneum is carefully dissected up by the finger passed 
through the hernial opening as far as possible with the finger. Ab- 
dominal wall is then cut in the linea alba above and below, using the 
finger as a director. Opening is thus converted into an ellipsoid. 
Four or five sutures are now passed through the muscle and sheath of 
the rectus. These are knotted and left long. These ends are car- 
ried separately beneath the muscle on the opposite side, and penetrate 
it at a point about an inch from the free margin. The two ends come 
up through the muscle and its sheath at separate points. Strong 
traction is made on them, thus forcing the edge of one rectus beneath 
the other. When all sutures have been passed, tightened and knotted 
in this manner, an ellipsoidal overlapping of the recti has been secured 
at point of herneal opening. The free edge of the rectus that has been 
penetrated by the sutures is now drawn over and secured by inter- 
rupted sutures to the sheath of the other muscle. Superficial fascia 
and skin are then united. 

Fractures. — Lancet, May 26, 1900. W. Arbuthnot Lane insists 
that in simple fractures, if the surgeon fail to obtain accurate opposi- 
tion, he should cut down at site of fracture and restore bones to their 
original form. 

Hip joint disease.— Arthur E. Barker {Lancet, May 26, 1900) 
believes in operating in hip joint disease before sinuses form. Joint 
should be flushed with hot water, all sequestra and spiculae removed 
with gouge, parts dried, a small quantity of iodoform emulsion intro- 
duced. After results of operation have been excellent. Patients 
walked well, without pain, although there was considerable short- 
ening. 

OsTEO MYELITIS.— In an article in Annals of Surgery, October, 1899, 
Haywood W. Gushing, Boston, details history of a case of acute osteo 
myelitis of tibia, and shows method adopted for restoration. He 
summarizes as follows : The indications for treatment in cases of 



174 MEDICAL SOCIETY OF NEW JERSEY. 

acute osteo myelitis are (i) to save life and relieve pain by immediate 
• operation, to establish free drainage. Medullary cavity should be 
opened, pressure relieved and infection checked. (2) If bone is killed, 
as it usually is in a few days, it should be removed. (3) Most favor- 
able time for removal is when periosteum and granulation tissues are 
in their most active regenerative stage, but before process of calcific- 
ation of the bone trabeculae have shut in the sequestrum. (4) The 
point is to be determined by frequent examinations of sections of per- 
iosteum by the microscope. It is shown by the presence of numerous 
fibro blasts, osteo blasts and small trabeculae in which lime salts are 
beginning to appear. (5) Clinically it is recognized by the slight 
crackling sensation as periosteum is incised. (6) Periosteum at this 
stage resembles granulation tissue' in color, density and vascularity. 
Bone will be formed from this elastic, flexible periosteal layer. (7) 
This stage will probably be reached in the seventh or eighth week of 
the disease. (8) At this stage necrotic bone should be removed by 
incision in periosteum in the long axis of the bone and shelling out 
sequestrum. (9) Periosteal sheath remaining should be closed by 
suture, leaving a solid cord or mass of periosteum, buried in the 
center of the leg, when in the most active bone producing condition. 
(10) Areas of calcification of any extent or thickness, adherent to 
inner surface of periosteal sheath, should be dissected off. (i i) Soft 
parts and skin should be closed by suture. (12) Operation should be 
as nearly aseptic as possible. (13) New bone is formed rapidly, appar- 
ently in from eighteen to twenty-four days. (14) If operation is done 
too early, growing periosteum is injured and growth interfered with. 
(15) If too late, a bony involucrum makes removal of sequestrum 
more difficult and forms a cavity difficult to close. (16) It is demon- 
strated by radiograph that medullary cavity is reformed in the new 
bone. (17.) Shape of tibia is easier to restore than the epiphysis. 

Deformity and loss of function following colles's- 
FRACTURE.— 7?^2/. d' Orthopedic, July, 1899.) Marchand reports 
this case : Patient fell from a tree and fractured both wrists. They 
were set and united well, with no loss of function. For some time 
before presenting himself patient had noticed increasing loss of func- 
tion. There finally appeared a very noticeable deformity of left wrist. 
There was marked prominence of the ulna. A skiograph confirmed 
the opinion that the development of the radius had been interfered 
with in consequence of the involvement of the epiphysis by the frac- 
ture, while the ulna had continued to grow. A resection of the ulna, 
corrected the deformity and restored perfect function. 



ADDENDUM 



TO 



REPORT OF STANDING COMMITTEE. 



fin Mtmoviam. 



SAMUEL H. PENNINGTON, M.D., 

Born October 6, i8c6. 
Died March 14, 1900. 



F. E. NOBLE, M.D.. 

Born July i, 1824. 
Died June 29, 1899. 



JOHN J. CUNNEELY, M.D., 

Born November 20, 1857. 
Died September 30, 1899. 



WILLIAM GLATZMAYER, M,D., 

Born February 2, 1858. 
Died March 7, 1900. 



Ctt Mtmoxiam. 



LLOYD WILBUR, M.D., 

Born August 4, 1 830. 
Died January 27, 1900. 



CHARLES H. VOORHEES, M.D., 

Born August 3, 1824. 
Died May 13, 1900. 



A. D. JOUSSET, M.D., 

Born May i, 1851. 
Died December 8, 1899. 



DILLON DRAKE, M.D., 

Born October 16, 1864. 
Died May 2, 1900. 



IRWIN FISHER, M.D., 

Born July 29, 1875. 
Died December 3?, 1899. 



18 



M Mtmoviam. 



JOSIAH REEVE, M.D., 

Born November 28, 1842. 
Died December 25, 1899. 



DILLWYN PARRISH PANCOAST, M.D., 

Born March 1 1 , 1 836. 
Died November 4, 1899. 



BENJAMIN S. LEWIS, M.D., 

Born January 28, 1857. 
Died March 9, 1900. 



HAMILTON MAILLY, M.D., 

Born January 4, 1867. 
Died August 30. 1899. 



CHARLES H. WINANS, M.D. 

Born October 31, 1864. 
Died November 22, 1899. 



fin Mtmoxiam. 



IRVING F. HARLINGEN, M.D., 

Born July 29, 1875. 
Died December 31, 1899. 



JOSEPH P. COUSE, M.D., 

Born October 9, 1841. 
Died April 12, 1900. 



JOHN S. COOK, M.D., 

Born January 19, 1827. 
Died January i, 1900. 



I 



T. J. JACKSON, M.D., 

Born July 13. 1853. 
Died October 26, 1899. 



T. W. HARRIS, M.D. 

Born August 9, 1858. 
Died May 17, 1900. 



OBITUARIES. 



DILLWYN PARRISH PANCOAST, M.D. 

Dillwyn Parrish Pancoast was born at Mullica Hill, Gloucester 
County, N. J., March ii, 1836, and died at the Cooper's Hospital, 
November 4, 1899. After graduating from the Marietta Academy 
when he was 17 years of age, and the Philadelphia College of Phar- 
macy when he was 20 years of age, Dr. Pancoast entered the Univer- 
sity of Pennsylvania and was graduated from the medical department in 
1859. Immediately following his graduation he settled at Chestnut 
Hill, Pennsylvania, and was appointed physician to the Bethesda 
Home of that place. In 1862 he entered the United States army as 
contract surgeon, in which capacity he remained until 1866, when he 
resigned and came to Camden where he engaged in professional work. 
In 1 87 1 Dr. Pancoast became a member of the Camden District 
Medical Society and in 1879 was elected its President. He resigned 
from active membership in 1889 and in 1890 was elected an honorary 
member. 

Dr. Pancoast was active in charitable work, serving for several 
years as a mfember of the Board of Managers of the Camden City 
Dispensary, to which position he was elected in 1876, and also one of 
the attending physicians of the Cooper Hospital having been appointed 
an original member of the staff of that institution in 1887. In 1888 
Dr. Pancoast retired from active practice and severed his relations 
with the several medical societies and institutions with which he was 
connected and removed to Mullica Hill, the scene of his boyhood 
days, where he resided until he was overtaken with the fatal illness. 

Dr. Pancoast was a type of the Christian physician. In demeanor, 
quiet ; in manner, dignified ; in contact with suffering, most gentle 
and considerate. It can be said of him " he went about doing good," 
giving of his time, his skill and his means to help mankind. He was 
beloved by his fellow-practitioners, and his patients affectionately 
regarded him as a friend and safe counsellor in time of sorrow and 
woe. 



1 82 MEDICAL SOCIETY OF NEW JERSEY. 

BENJAMIN S. LEWIS, M.D. 

BY H. H. SHERK. M.D. 

Dr. Benjamin S. Lewis, son of Charles and Margaret F. Lewis, was 
born in the city of Camden. January 28th, 1857, and died on March 
9th, 1900, aged 43 years. 

After receiving his education in the public schools of his native city, 
he ented the printing business, and was for a number of years proof- 
reader on the ** North American," a daily paper published in Phila- 
delphia. 

Having a desire to enter upon the practice of medicine, he entered 
the Jefferson Medical College, and was graduated from that institution 
in 1887. 

Being of a bright and cheerful disposition, he was beloved by all 
who knew him. By his personal magnitism he won to himself many 
friends. He was a learned and fluent talker, and his bright speeches 
were well received on the floor of the societies to which he belonged. 

For a number of years he filled the office of secretary of the Camden 
District Medical Society with marked ability, 



HAMILTON MAILLY, M.D. 

BY ELLSMERE STITES, M.D. 

Dr. Hamilton Mailly was born in Odessa, Delaware, January 4, 
1867. His father was Charles Edward Alexis Mailly, whose birth- 
place was a suburb of Lyons called Croix Rousse; his grandfather 
was Jean Baptiste Augustine de Mailly, and was born in Lyons, 
France. The family of de Mailly was one of the oldest in France 
and took its name from the property of Mailly, now Amiens or 
Rheims. They had also the title of Marquis of Nesle. and were 
Counts de Mailly. Their title goes back to the eleventh century. 

After finishing his preparatory education in that place he came to 
Bridgeton and in 1887 entered the office of Dr. T. G. Davis to further 
prepare for the study of the profession he had chosen for his life 
work. In the fall of 1888 he entered the medical department of the 
University of Pennsylvania, and graduated in the spring of 1891. 
He at once began the practice of medicine in Bridgeton, and during 
the nine years that followed he had won to an unusual degree the 



OBITUARIES. 183 

esteem and confidence of his professional associates, as well as the 
admiration of a wide circle of friends. His death occurred on the 
thirtieth day of August, 1899, and brought to a sad and untimely end 
the life of one who was respected, loved and honored, not only by the 
profession but by the community in which he lived. 

The task imposed upon me of writing this biographical sketch is 
one both of sorrow and pleasure ; of sorrow at the loss of a true, tried 
and steadfast friend ; of pleasure such as comes to all who dwell on 
the sterling qualities of those they love. To every one who had the 
good fortune to know him his death will come as a personal loss. I 
shall suffer as keenly, perhaps, as any member of the profession, for 
the reason that possibly I knew him better. As students together in 
college we were very close ; in short, we lived together, and in this 
way I had every opportunity to know his personal characteristics, his 
disposition as a friend and his ability as a student. He was simple 
and unaffected in manner, kind and courteous in his treatment of 
every one, slow to take and even slower to give offense, broad in all 
his views of life and its complex relations, modest to the point of 
diffidence where his own merit was concerned, earnest and sincere 
without being quarrelsome, good, with no shadow of self-righteous- 
ness, he seemed to hold up to poor human nature examples that 
should stimulate and encourage even the worst or weakest among us. 

As a physician, he was honest in thought and in action ; he always 
did the thing which he believed to be the best for his patient; 
in short, he was conservative, thoroughly skilled and wise — high 
qualities possessed by few, So many good things said of friends 
deceased, can often be taken with a degree of consideration, as coming 
from one who has been favored by some special act of kindness ; but 
the many stable elements of this man's character will be remembered 
by all who had the pleasure of knowing him. 

in estimating the true value of a physician, we can best be guided 
by the opinion of his professional colleagues, for the laity are essenti- 
ally unfit to pronounce upon his ))rofessional ability. They are too 
apt to mistake show for brilliancy, self-assertion for force of character, 
and notoriety for fame. He had many warm friends in the profession 
who well knew his sterling qualities, and here I cannot do better than 
to quote from one who knew him well, and wrote his obituary sketch 
at the time of his death : •* Dr. Mailly had a profound detestation of 
cant and hypocrisy, and under all circumstances and at all times had 



1 84 MEDICAL SOCIETY OF NEW JERSEY. 

the courage of his convictions, and was able to give expression to 
them in a forcible aijd logical manner. It was sufficient for him to 
believe a thing was right and no considerations of expediency or fear 
of consequences ever swerved him from his convictions, or led him to 
act in opposition to them, He was perhaps too prone to subject 
everything to a standard of reason and logic, but his evident sincerity 
and conscientiousness always commanded the respect even of those 
who felt compelled to differ from him. Professionally he was the 
soul of honor, and I do not recall ever having known him to do an 
unprofessional act or one unbecoming a gentleman." 

Dr. Mailly's home life was most beautiful. He was a kind father 
and a devoted husband, always studious of the well being of his wife 
and child, who now survive him. 

At the time of his death he was secretary of the Cumberland 
County Medical Society, which position he held for some time. The 
society lost a valuable member and an able officer, but his associates 
have had taken from their ranks a colleague of more than ordinary 
ability and a friend upon whom they could depend and trust. It is in 
this capacity that he will be most missed and his loss most keenly felt. 



CHARLES HARRISON WINANS, M.D. 

Dr. Charles Harrison Winans was born at Rockland Lake, on the 
Hudson, August 31, 1864, and died at Liberty, N. Y., November 22, 
1899, at the early age of thirty-five. Dr. Winans received his literary 
education at Hackettstown Seminary, and on leaving school was 
apprenticed to learn the machinist's trade. After remaining an 
apprentice about two years the realization forced itself upon him that 
there were better things within his reach than his chosen trade offered, 
and he consequently became restive and unhappy. 

It was at this point in his history that he developed the ambition to 
study medicine. Under the influence of this thought and inspiration 
he called on a neighboring physician and unfolded to him his strong 
desire and purpose. Receiving some encouragement from this visit, 
and although absolutely without pecuniary means either immediate or 
prospective, he at once resolved and entered upon the fulfilment of 
his pet scheme, and while compelled to earn his own maintenance he 
devoted his spare time to the elementary study of medicine. From 
this on, for five years, he contended with the unequal task he had set 



OBITUARIES. 185 

for himself. At the end of this period he found himself in position 
to matriculate at a medical college, which he did at the College of 
Physicians and Surgeons, Baltimore. At the expiration of one year 
spent there his means were exhausted and he was compelled to again 
resort to work for his support. Later on, while by the continued self- 
sacrifice and effort above indicated, he entered the University Medical 
College, New York, from which institution, after a two years' course, 
he graduated with honor in the spring of 1890. 

Immediately upon his graduation he settled in Belleville, this State, 
and very early was engulfed in the full tide of an engrossing practice. 

4 

As the years passed on, bringing with them an increased clientelle 
and thus increased labor and responsibility, it became apparent to his 
friends that the burden was becoming too heavy for him to safely 
undertake to bear, and that he must either relinquish his increasing 
toil or satisfy the sacrifice with impaired health, if not with his life. 
It was about at this juncture, when his forces were becoming visibly 
undermined, that at the earnest solicitation of those especially inter- 
ested in him, he temporarily abandoned practice and went abroad. 
He returned from this journey much recuperated, but upon his re- 
sumption of his extensive practice he soon lost what he had gained^ 
and the result was that he utterly broke down in the ninth year of his 
professional life, and passing rapidly into pulmonary tuberculosis, 
died as above stated. 

In passing in brief review the special characteristics of Dr. Winans 
as a man and physician, we are at once attracted by his untiring per- 
sonal and professional devotion to his patients. Naturally, this devo- 
tion not only endeared him to his clientelle, but no doubt contributed 
largely to his somewhat brilliant career as a practitioner, for seldom 
is it seen that a young physician so rapidly attracts to himself so- 
large, influential and devoted a following as the doctor enjoyed. It 
appears that his very presence and manner begot friendliness and 
confidence with the rich and poor alike ; so that so far as his personal 
acquaintance extended, just so far was a favorable reputation estab- 
lished. While not a manjof large scientific attainments, an extremely 
tactful exercise of those he did possess, together with the confidence 
inspired by his pleasing personal qualities above alluded to, rendered 
Dr. Winans an unusually successful practitioner of his profession,, 
and his career somewhat notable as estimated by the standard of 
practical, professional and pecuniary achievement. 



1 86 MEDICAL SOCIETY OF NEW JERSEY. 

WILLIAM GLATZMAYER, M.D. 

William Glatzmayer was born in Brooklyn, N. Y., February 2, 1858. 
He was a delicate boy and was sent abroad for his health. He at- 
tended school in Kempten, Bavaria. On his return to the United 
States he entered the New York College of Pharmacy, from which he 
was graduated in 1878. He was employed as a drug clerk for several 
years, and during that time studied medicine. In 1885 he received 
a degree of Doctor in Medicine from the University of the City of 
New York and at once came to Newark to accept the appointment of 
house physician to the German Hospital. Completing the term of 
service of a year and a half, he began general practice and soon had 
abundant employment. In 1888 he was married, but had no children. 

He was an active worker in his profession, but found time to devote 
to the furtherance of his political ambitions. In 1898 he was elected 
by the Democratic party to represent his ward in the Common 
Council of Newark. The precarious condition of his health prevented 
his attending to the duties of alderman with his customary energy. 
For nearly four years he sought to recover the health that kidney and 
liver troubles were slowly undermining. There were fluctuations of 
success and failure, but at last the end came on March 7, 1900. 



SAMUEL HAYES PENNINGTON. M.D. 

Samuel Hayes Pennington was born in Newark, October 16, 1806. 
He died March 14, 1900. He was a scion of one of New Jersey's 
most distinguished families, which had given two Governors and a 
Chancellor to the State. His cousin, William Pennington, was a 
member of the House of Representatives of the United States and its 
speaker just previous to the outbreak of the rebellion. Dr. Penning- 
ton received his preparatory education at the Newark Academy, from 
which he was graduated in 1823. In this year he was entered in the 
junior class of the College of New Jersey at Princeton. He received 
his A.B. in 1825 in a class that numbered among its members several 
who afterwards became men of marked distinction. Immediately 
after graduation he commenced the study of medicine and attended 
lectures given by the Rutgers Medical Faculty, connected with the 
Geneva College, among whom were the distinguished medical men 
David Hossack and John W. Francis. 



OBITUARIES. 187 

In 1828 Princeton conferred upon him the honorary degree of A.M., 
and in the next year he was graduated in medicine. He then began 
the practice of his profession in Newark, forming a partnership with 
his uncle, Dr. Samuel Hayes. In 1839 he succeeded to the practice. 
He was then a man of great activity, extensive ambition and acknow- 
ledged skill, and soon became an authority among his medical 
brethren. He atquired an extensive consulting practice. In 1851 he 
was among the foremost in the establishment of the Newark City 
Bank and was made its first president, a position he held at the time 
of his death. He guided the destinies of the bank with such wisdom 
that it is now one of the foremost financial institutions of the State. 

His love of learning was so great that he cordially fostered all 
■efforts for its advancement. For seventeen successive years he was 
elected to the Public School Board of Newark, and for seven years 
presided over its deliberations. In 1833 he was made a trustee of the 
Newark Academy, becoming the president of the board in 1854 and 
holding the position continuously until his death. In 1856 he was 
made a trustee of Princeton College and was for many years previous 
to his death the senior member of the board. So intense was his 
Interest in the welfare of his beloved alma mater that, until receiving 
an injury to his hip some five years ago, he never failed to be present 
at the meetings of its governing body. 

Princeton further honored him. The Theological Seminary, at the 
time one of the most influential in this country, made him a member 
of its board of trustees. For many years he held the office of presi- 
dent of the board. Dr. Pennington was thoroughly imbued with the 
Princeton spirit. He was enthusiastic over the success of his alma 
mater in letters, and also in its sports. Even after his bodily infirmity 
<;onfined him to his room he sought early news of contests and list- 
ened eagerly and with a glowing fire and kindling eye to the recital of 
how the field was won. In 1895 his college conferred upon hint the 
honorary title of Doctor of Laws. 

Early in his professional career he became prominent in the Medical 
Society of Essex County. He was for several years its secretary as 
well as its president. He was President of the State Medical 
Society in 1848. Fifty years afterwards the Society honored itself 
and him by making him one of its honorary members. The State 
Medical Society of Connecticut many years ago put his name on its 
foil of honorary members. He was also a corresponding member of 



1 88 MEDICAL SOCIETY OF NEW JERSEY. 

the Medical Society of Munich, and of the Royal Botanical Society 
of Ratisbon. One year ago this society made Dr. Pennington its only 
honorary member. 

Dr. Pennington was a clear and vigorous writer and during his 
medical life made a number of valuable contributions to medical 
science. He also composed a number of essays on educational sub- 
jects and delivered a number of addresses on subjects of contempor- 
aneous interest. He was a skillful controversialist of many resources. 
To the day of his death, although for many years not engaged in 
active practice, he was profoundly interested in the progress of medi- 
cine, and was eager to hear of the efforts to alleviate or to cure. He 
was an uncompromising opponent of quackery in any guise. He was 
a man of eminently distinguished appearance, of great dignity of 
carriage and demeanor, but withal of much geniality of manner, a 
most enjoyable companion. 

Several years previous to his death a fracture of the hip put an end 
to his most remarkable activity. Increasing deafness closed to him 
one of the delights of living, and progressive dimness of sight made 
the acquirement of information most difficult, but a table close to his 
chair and tilled with books and magazines devoted to all branches of 
literature, showed with what persistence he endeavored to overcome 
his infirmities. 

An incident at the very close reveals several most characteristic 
traits. A period of more than usual brightness and apparent well- 
being had been very suddenly interrupted by a slight confusion of 
intellect, some thickness of speech and vacancy of expression, with 
weakness of the left side. The gravity of the seizure had been 
recognized by the physician in attendance and vigorous orders had 
been laid down. At the third visit the physician found the patient 
seated in his wheel-chair under a bright gas light. In the stead of 
his left arm, now absolutely powerless, an attendant was holding an 
evening paper, while with the help of a powerful magnifying glass 
Dr. Pennington, with painful persistence, was very slowly deciphering 
an article in a controversy in which he was profoundly interested. 
The physician waited. Dr. Pennington read on, finally reaching the 
end. Looking up and seeing the physician, he exclaimed, "Ah,. 
Doctor, is that you ? I am glad to see you. I want you to translate 
this Latin for me, I can't seem to make it out." And this was the 
last .of many delightful interviews. . . 



OBITUARIES. 1 89 

FRANCIS EUGENE NOBLE, M.D. 

Francis Eugene Noble was born at Rochester, N. Y., on July i, 
1824. Shortly after his family moved to Dexter, Michigan, where he 
spent the earlier years of his life. He attended one course of medical 
lectures at the Albany Medical College, at Albany, N. Y., in 1847-48, 
and two at the medical department of Western Reserve College, at 
Cleveland, Ohio, 1849-51, and was graduated therefrom on February 
26, 1 85 1. He commenced the practice of medicine at Dexter, Michi- 
gan, and remained there until October, 1852. 

In 1852, he moved to California, and settled near Sacramento, and 
lived there for nearly three years, after which he established himself 
at Michigan Bluff, Placer County, remaining there until April, i86o, 
when he returned to the East ; and, in November, settled in Hudson 
City (now part of Jersey City). 

He was superintendent of public schools in J 866; and, again, in 
1869. He was a member of the visiting staff of the Hudson County 
Hospital from its foundation, afterward of Christ Hospital, until he 
resigned a few years before his death. He was the physician of St. 
Katherine's Home at the time of his death. He was a member of the 
Hudson County Pathological Society, of the Hudson County Medical 
Society, and of the American Medical Association. 

He continued his practice of medicine until the commencement of 
his last illness, a few days before his death, which occurred on June 
29th, 1899. He was universally respected, beloved by a large circle 
of patients and friends, a thoroughly sincere, honest and honorable 
man, and a most excellent and conscientious physician. 



DR. H. C. CUNNEELY, M.D. 

Dr. H. C. Cunneely was born in New York city, November 20, 1857. 
He was graduated from Bellevue Hospital Medical College in i866 and 
immediately made a special course with Dr. Grinnell, of New York, 
practicing with him in the meantime at the Demilt Dispensary. He 
took the competitive examination for St. Vincent's Hospital in 1887, 
and won the appointment on the house staff, making while there a 
special record for a low mortality rate and earning the respect of the 
visiting staff. After his term was completed at the hospital and a 
thorough knowledge of the surgical and medical branches had been 
acquired, he established himself in East Ninetieth street, New York, 
and soon built up a creditable practice. 



igO MEDICAL SOCIETY OF NEW JERSEY. 

This he was induced to leave by friends, and 1893 found him ii> 
Hoboken. He held a good part of his New York practice until his 
growing practice in Hoboken compelled him to relinquish it. His 
discriminating judgment and power of true diagnosis were character- 
istic of his professional services. These, added to his surgical skill 
and conscientious discharge of duty, had already gained for him local 
recognition and respect. His untimely taking off on September 30, 
1899, on account of overwork, put an end to a career that was full of 
promise. He had been a member of the New York County Medical 
Society but severed his connection with the society on his removal to 
this State. 

CHARLES H. VOORHEES, M.D. 

BY ARTHUR L. SMITH, M.D. 

Charles Holbert Voorhees. M.D., of New Brunswick, N. J., died on- 
Sunday, May 13. 1900, after quite a protracted illness. He was born 
in New Brunswick, August, 3, 1824. received his early education there, 
and his medical degree from Jefferson Medical College, in 1850. He 
began practice in Spottswood, later going to Plainfield and Phila- 
delphia, but finally settled in New Brunswick, in 185$, where he 
remained until his death. 

Dr. Voorhees was a member of the Middlesex County Medical 
Society, and was a permanent delegate to the New Jersey State Medi- 
cal Society. He was a member of the 9th International Medical 
Congress, which met at Washington in September, 1887, and read a 
paper before the section on military and naval surgery, entitled, "Are 
wounds from explosive bullets of such a character as to justify inter- 
national laws against their use?" Dr. Voorhees had always been 
interested in military matters, having served with distinction during 
the War of the Rebellion. He was the author of numerous scientific 
and literary papers, and until the infirmities of age prevented, he took. 
an active interest in the medical and social life of his city. 



LLOYD WILBUR, M.D. 

BY GEORGE E. TITUS, M.D. 

Dr. Lloyd Wilbur, of Hightstown, N. J., was born at Red Valley,. 
Monmouth County, N. J., on August 4, 1830. His father was a^ 



OBITUARIES. igy 

prominent farmer of that section. Dr. Wilbur attended Trenton- 
Academy, but was graduated from Pennington Seminary in 1848.- 
Up to the time of his death he was the oldest living graduate of that 
institution. After completing his studies at Pennington he taught 
school for two years near his home and in 1850 commenced the study 
of medicine at New Egypt under the then Governor of New Jersey 
Dr. Geo'rge F. Fort. In 1852 he entered Jefferson Medical College 
and was graduated in 1854. He then located at Hightstown, N.J.,. 
where, up to the last few years of his life, he had a very large practice. 
He was especially sought for by his fellow-practitioners in difficult 
cases, and his professional loyalty and ability were such that his 
presence was always welcome. If there was any recommendation to 
be made it was done in the consulting room and no act or word of 
his was disloyal to his confrere, and at the same time the patient 
received the benefit of his services to the utmost extent. 

How often the writer will remember, when a consultation was de- 
cided upon and Dr. Wilbur was selected, the comfort and satisfaction 
he gave when he entered the sick room - no fear that professional 
jealousy would mar the consultation nor that the patient's interests 
would suffer. The medical fraternity of this section will feel his loss- 
continually, as he was almost a father in his kindness to us of a 
younger generation who often needed his assistance. 

Dr. Wilbur was a member of the Presbyterian church, having 
joined that church in 1868. He was one of the Board of Trustees of 
the Cortlandt Van Rennsaller Memorial Institute while it was in 
existence here. Princeton University conferred upon him the honor- 
ary degree of Master of Arts. He was very prominent in public 
affairs. He was of New Jersey's delegates to the Republican con- 
vention which nominated Lincoln for President for the second term. 
In 1887 he was appointed Superintendent of Schools of Mercer 
County, which office he filled for six years. At the expiration of this 
period he was appointed State Supervisor of the School Census which 
office he filled for four years, or until it was abolished by legislation. 

During his occupancy of the office of County Superintendent the 
borough of Wilbur, of the city of Trenton, was incorporated and 
named in his honor. He was a prominent member of the Mercer 
County Medical Society having joined that organization in the early 
years of its existence. He married Miss Caroline C. Shinn, of New 
Egypt, by whom he had two sons — Dr. G. F. Wilbur, of Asbury 



192 MEDICAL SOCIETY OF NEW JERSEY. 

Park, and Dr. William L. Wilbur, of Hightstown. He was a man of 
character and personality entirely his own, but under all his brusque- 
ness of manner and peculiarity of disposition there was a heart as 
loyal and kind as a woman's. Skillful, tender and full of resources 
he was a typical country doctor, and those who lived under his influ- 
ence will cherish to the day of their death many of the kindnesses of 
our highly esteemed and greatly lamented Dr. Wilbur. He died on 
Saturday, January 27, 1900. in the seventieth year of his age. "He 
was our friend and we were his. Above his clay we pay this tribute 
to his worth." 



DILLON DRAKE, M.D. 

BY JOHN R. MERRILL, M.D. 

Dr. Dillon Drake was a member of the Passaic County District 
Medical Society at the time of his death, on May 2. 1900, having 
resided and practiced in Paterson and vicinity for about the period of 
six years. 

He had formerly resided in Philadelphia, Pa., his parents' home, 
although his birth occurred while his parents were sojourning at 
Weisbaden, Germany, during iheir travels in Europe. 

After his education in Germany was completed, he came with his 
parents, on their return home to Philadelphia, their place of residence, 
and, in due course of time, he was graduated at the Jefferson Medical 
College, Philadelphia, on April 2, 1 890 ; was connected with active 
duties in " The Philadelphia Lying-in-Charity," and served one year 
in the St. Agnes Hospital, Philadelphia ; practiced as a private physi- 
cian in Philadelphia for a short time ; and, then, further pursued his 
medical studies in Vienna, and after a four years' course in special 
study of Dermatology, graduated and returned to this country, locat- 
ing in Paterson, N. J., in 1 894, 

During the latter part of his professional career. Dr. Drake showed 
the sterling qualities of a faithful physician battling bravely against 
heavy odds of ill health and the painful ravages of multiple arthritis 
deformans. He was courageous to the end, and through months of 
debility, at times while confined to his office reclining on a couch, he 
would minister advice to many confiding patients who sought him. 

The disease he had fought so invaded his finger joint, that opera- 
tive procedure was deemed necessary to remove necrotic tissue. 



OBITUARIES. 193 

but the infection had so invaded the system that after about a week's 
lapsing into semi-unconsciousness, he passed peacefully away. 
Funeral services were held at his home privately, and interment at 
Philadelphia. 

Dr. Dillon Drake was a son of Cunningham Drake, of Philadelphia, 
and of Mary Packwood Drake, of New York City, and was a grand- 
son of Dr. Alfred Drake, a former wealthy physician of Philadelphia. 
Being liberally educated in Europe, he was also conversant with the 
German and French, and a student of the Italian languages ; he was 
most companionable in disposition and interesting in conversation. 

He leaves a wife, a most estimable lady, whom he married in 1895, 
who has been his good cheer and a noble help-meet. His memory 
remains as that of a courageous physician fulfilling his duties to the 
end bravely. 

ALBERT DE MEfi JOUSSET, M.D. 

BY JOHN R. MERRILL. M.D. 

Dr. Joussett was born May i, 185 1, in Bordeaux. France. He was 
a volunteer in the Franco- Prussian war. Company 35, Battalion 8, 
Infantry. After the war he came to this country, and after a time 
spent in business as importer, he studied pharmacy, graduating from 
the New York College of Pharmacy in 1874. Entering the drug 
business at West Brighton, Staten Island, he continued there from 
1878 to 1884, when he came to Paterson. He was studying medicine 
during the period just named and graduated from Bellevue Hospital 
Medical College in 1883. 

Dr. Jousset was a very active man in the practice of his profession 
and had recently entered a fine new place of residence in a very 
desirable locality, and after a few months enjoyment of that, the sad 
news was spread that he was suffering from diphtheria. While in 
the performance of his professional duties to a patient affected with 
that disease, he was himself infected and succumbed to the dread 
enemy after a few days illness. He died December 8, 1899. 



JOSIAH REEVE, M.D. 

BY N. NEWLIN STOKES, M.D. 

Josiah Reeve, M.D., was born near Medford, N. J., November 28, 
1842. He commenced his medical studies in the office of his uncle, 

13 



194 MEDICAL SOCIETY OF NEW JERSEY. 

Dr. Henry Ely, and graduated at the University of Pennsylvania in 
the year 1863, and in the same class with the late Dr. William Pepper^ 
with whom he always continued on terms of friendship. Dr. Reeve, 
after serving one year ancl a half in the Philadelphia Hospital, settled 
in Medford, N. J., forming a copartnership with his uncle, Dr. Ely, 
and at once became a painstaking and useful physician, much beloved 
by his patients and professional friends. 

His industry and conscientious and self-sacrificing nature were re- 
markable, never hesitating to respond to professional calls at all 
seasons, giving freely his time and skill to all classes alike. His 
parents were members of the Society of Friends. Though not a 
member of this religious organization at the time of his decease, his 
sympathies were with them, dying in full faith and love for his Saviour, 
with a blessed assurance that eternal life through Him was granted. 
We reverently believe he is now enjoying the rich reward of a well- 
spent and useful life. He died on the 25th of December, 1899, aged 
fifty-seven years. A widow, two sons and a daughter survive him. 



IRWIN FISHER, M.D. 

In the sudden death of this younger member of the profession the 
medical fraternity has lost one of whom much was to be expected^ 
Born July 29, 1875, he early evidenced a liking for medical study, and 
after a careful preliminary education he entered Rutgers College, at 
New Brunswick, N. J., to fit himself more fully for the medical school 
to follow. His desire to enter upon his professional studies, however, 
became so strong that after two years at Rutgers he left that institu- 
tion and entered the Medico-Chirurgical College, at Philadelphia, from 
which school he graduated with honor in 1896. In July of the same 
year he entered upon his active work at Harlingen, N. J., and soon 
enjoyed a successful and lucrative practice. December 31st, 1899,. 
after complaining of a slight feeling of general distress the evening 
previously, he was found lifeless in bed, death having taken him ap- 
parently without a struggle. 

Of his abilities as a physician, the practice that he won and held in 
his brief career is sufficient evidence. Of his character as a man, the 
esteem of his neighbors and of his fellow-members of the Somerset 
District Society is a silent witness. Loyal to his duty, tireless and 



OBITUARIES^ ]gi 

» 

skillful in its perloTm^Ticc, ever ready to extend his l^nowledge for the 
relief of suffering humaTiity, his death came as a cruel shock to those 
•who knew him tntiiwately. 

JOSEPH P. COUSE. M.D. 

Dr. Joseph P. Couse was born in Frankford Township, Sussex 
County, N. J., October 9, 1841. His father, John P. Couse, and 
mother, Jane Coult Couse, were thrifty, intelligent people who believed 
in education, and therefor the son was sent to a private school at 
Milford, Pa., whose principal was Ira B. Newman. After leaving 
school he taught for a season until called to the management of the 
homestead by the death of his father. In 1863 he enlisted as a private 
in Company H. Thirty-third N. J. Volunteers, and was mustered in* 
second lieutenant, August 26 of the same year. September 25, 1864,- 
he was promoted to first lieutenant and April 4, 1865, attained the 
rank of captain of Company I, accompanying Sherman in his cele^- 
brated march, taking part in the battles of Chattanooga and Atlanta, 
and also in the campaign through the Carolinas and to Savannah, 
being mustered out with his regiment at the close of the war. 

Soon after the close of the war he began reading medicine with Dr.- 
Hedges, of Branchville, N. J., and two years later entered the Univer-' 
sity of Michigan, at Ann Arbor, from which school he graduated ini 
1870. After one year's practice at Franklin, he took a post-graduate 
course at Columbia College, receiving his diploma therefrom in 1873. 
A year later he formed a partnership at Hamburg with Dr. William 
Linn, which continued until the death of Dr. Linn. Since that time 
Dr. Couse practiced at Hamburg until his death which occurred April 
12, 1900. 

In his thirty years of practice Dr. Couse had won a wide and envi- 
able reputation among the laity, the esteem, respect and love being 
manifest on all sides. Added to his kindness of heart was a soul so 
large as to take in all mankind and, forgetting self, render unto eveiv 
the most lowly the care and treatment that never would be repaid,, 
even when it called for great physical suffering on his part. Honor- 
able in all his dealings, faithful to his friends, strong in his love for 
his profession, his loss has caused the whole profession in northern 
New Jersey to mourn the brother, friend and physician whose example 
we can but emulate. Mrs. Hannah (Giveans) Couse, to whom the 
Doctor was married in 1877, with their three daughters, survive him. 



196 MEDICAL SOCIETY OF NEW JERSEY. 

Soon after graduation Dr. Couse identified himself- with the District 
Medical Society for Sussex County, and until his death was a respected 
and honored member, receiving the highest office in the gift of the 
society and gaining the individual respect and esteem of its members. 
He was strictly honorable in all his dealings and made the profession 
of medicine not a little poorer by his death. 



THOMAS JEFFERSON JACKSON, M.D. 

Dr. Thomas Jefferson Jackson, whose sudden death shocked the 
community of Springfield and vicinity, October 26, 1899, was born 
at Milton, Md., July 13. 1853. He was educated in the schools of 
that place and at the University of Virginia. He graduated from the 
College of Physicians and Surgeons, Baltimore, with the class of 1879. 
He opened an office in Harford County, Va., that same year, where he 
continued to practice until 1890, when he came to Springtield. Dr. 
Jackson was a member of the Union County District Medical Society 
and the American Medical Association ; he was a Free Mason and a 
Knight Templar in the order; he was also a member of Columbo 
Council, No. 1492, Royal Arcanum, and of the Fraternal Union. Dr. 
Jackson was a member of the Board of Education of Springfield 
Township and served as its president, and was also at one time the 
vice-president of the Board of Trade of Springfield and Milburn. 
Dr. Jackson is survived by a wife, n6e Annie S. Mapp, daughter of 
Victor A. Mapp, of Northampton County, Va., and three children — 
Mrs. Oliver H. Leber, and Walker and Earl Jackson, of Springfield. 



T. W. HARRIS, M.D. 

BY WM. HOPPAUGH, M.D. 

Theodore W. Harris was born at Cromwell, Conn., August 9, 1858. 
When about seven years of age he removed with his family to Sag 
Harbor, Long Island, where his mother and sister still reside. He 
studied medicine at the College of Physicians and Surgeons in New 
York City, where he graduated in 188 1. He then settled at Bridge- 
water, Conn., where he practiced medicine until December, 1889. 
when he removed to Springfield, N. J., where for a time he occupied 
the former office of Dr. Nicholas C. Jobs, who died in November, 
1889. He there built up a large practice and made many friends, as 



OBITUARIES. 197 

was also the case at Bridgewater. He died May 17, 1900, an opera- 
tion for appendicitis having been performed the day previous by Drs. 
Harvey, Runyon and Campbell. A funeral service was held in the 
Presbyterian church in Springfield, on Saturday, May 19, and a second 
service in a church at Bridgewater, Conn., the next day. He was 
buried at Bridgewater. A wife (who was Miss Annie Gertrude Jes- 
sup, of Bridgewater) and three children survive him. He was a 
member of the Union County Medical Society, of the Society for the 
Relief of Widows and Orphans (in Newark), of Success Council of 
Junior Order of United American Mechanics, and of Summit Council 
of the Royal Arcanum. At the time of his death he was president 
of the Board of Trustees of the Presbyterian Church in Springfield, 
and also president of the Board of Education for Springfield Township. 



JOHN S. COOK, M.D. 

BY JOHN C. JOHNSON, M.D. 

Dr. John S. Cook died at his home in Hackettstown, N. J., on the 
morning of New Year's Day, 1900. His disease was an acute affec- 
tion of the stomach and his last illness of brief duration and an abrupt 
termination of a career of nearly fifty years of almost continuous 
activity in his professional work. Dr. Cook was of a family many of 
whom were physicians. He was the fifth son of Dr. Silas C. Cook, 
and was born at Stewartsville, June 19, 1827, was less than a year 
old when his father removed to Hackettstown. He prepared for 
college here and attended Lafayette College and Union College, N.Y., 
from which he graduated. He studied medicine with his father and 
received his diploma from the University of Pennsylvania, March, 
1850. At once he began practice in Hackettstown. At various 
periods he had as partners his older brother, Lewis C. Cook, and for 
two years a younger brother. Dr. Joseph, both now deceased. 

As a man and citizen Dr. Cook was held in high esteem by all who 
knew him. His large public spirit and fine judgment made him in 
touch with all public enterprises for the benefit of his town. He was 
an active member of the Board of Education and *its president, and 
an advocate of the public improvements for streets and water supply 
which are of such substantial benefit to the town. He was a positive 
Republican in politics, but never sought preferment in that line. The 
only office he held was that of Pension Examining Surgeon. 



198 MEDICAL SOCIETY OF NEW JERSEY. 

Dr. Cook was a fine representative of the best type of what is 
called the general practitioner. When he began work Hackettstown 
was a village of i.ioo inhabitants, lying in a narrow valley bounded 
on each side by Schooley's and AUamuchy mountains, so his riding 
was extensive and laborious, and with his brother Lewis they did a 
large business, His personal traits added much to his equipment. A 
gentleman of fine form, of cultured tastes, with a refined and cheerful 
manner and a warm heart, his presence was welcome to the sick and 
his fine diagnosis and long experience inspired them with entire con- 
fidence. In the period when hospitals were no nearer than New York 
City Dr. Cook was an efficient surgeon, operating on those injured on 
the line of the Morris & Essex Railroad. In later years he was the 
consultant to many of his medical neighbors, to whom he gave good 
advice and also a recognition of their professional rights. 

His educational equipment and the natural bent of his mind for 
obtrusive reading appeared in his written addresses. He was presi- 
dent of the Medical Society of New Jersey in 1878. His address was 
upon " The problem of life." Besides his office in the Warren County 
Medical Society he was the first president of the Tri County Medical 
Society, composed of physicians of the counties of Sussex. Warren 
and Morris, and in October last his address at Washington was of the 
same type. His fondness for recondite reading and thoughts upon the 
deep things of life, although incapable of positive reach, gave him the 
spirit of investigation in his life work, and his experience was thus 
classified into positive ideas in therapeutics. His funeral was attended 
by a large delegation of his fellow-physicians and many citizens of 
the town. 

Dr. Cook is survived by his wife (who was a Miss Lewis) and six 
children, of whom Dr. Richard L. Cook, of Dover, N. J., is his sole 
representative in the profession. 



REPORTS OF DISTRICT SOCIETIES. 



ATLANTIC COUNTY. 

To the Chairman of the Standing Committee^ &c,: 

Meetings of Atlantic County Medical Society have 
been held at stated intervals during the year. A fair 
attendance is usually present. The meetings have been 
more of a business nature, probably, than scientific, due 
in a great measure to the regular meetings of the Atlantic 
City Academy of Medicine, at which meetings most of 
the papers are presented and discussed. 

Several new names have been added to the membership 
and none lost, either by death or removal, during the 
year. 

The illegal practice of medicine has commanded the 
attention of the Society and a committee appointed to 
secure legal advice for the prosecution of all offenders. 
Charges and prosecution have been inaugurated against 
two violators, with the result that these offenders have 
been proven guilty and their pernicious practices stopped. 
This act has had a wholesome effect upon the many 
offenders that annually settle here. 

The general health of the county has been good. But 
few small epidemics of the minor contagious diseases 
have existed. 

Interest of the county members has been expressly 
pronounced toward the State Society and the American 
Medical Association during the year, since both these 

meetings are to take place in this city this year. 

EMERY MARVEL. Reporter. 
Atlantic City, N. J. 



200 MEDICAL SOCIETY OF NEW JERSEY. 

CAMDEN COUNTY. 

To the Chairman of the Standing Committee^ &c.: 

The members of the Camden District Medical Society 
continue to manifest a healthy interest in the welfare of 
the organization. The quarterly meetings have been 
very well attended — scarcely a member absent and always 
a number of visitors present. The papers have been 
studiously prepared and attentively received. Many 
interesting cases have come to the notice of the mem- 
bers, some of which will be reported. 

The replies to the annual question, while not as numer- 
ous as formerly give such a comprehensive view of the 
subject that it will repay any one to read them. In 
order to clearly present this report it will be divided into 
four divisions, as follows: i. The meetings and the pa- 
pers presented. 2. Report of some interesting cases 
occurring in the practice of the members. 3. In memo- 
riam. 4. Answers to the question, ** To what extent 
does the charitable clinic curtail the revenue of the 
medical practitioner? 

I. The meetings and papers presented during the year. 

During the meeting held October 1 1, 1899, the sections 
on sanitary science and on microscopy and pathology 
presented reports. 

The reporter for the section on sanitary science was 
Dr. Joel W. Fithian, and his paper was entitled **Military 
sanitation." The members of the society listened to 
this paper with much interest, recognizing that its author 
spoke from personal experience. Dr. Fithian was assist- 
ant surgeon of the Fourth New Jersey Regiment — a 
regiment during the Spanish war regarded as a model in 
ob«^erving military sanitation. 

The reporter for the section on microscopy and path- 



REPORTS OF DISTRICT SOCIETIES. 20I 

ology was Dr. Frank Neal Robinson, and his paper was 
entitled "A resume of medical pathology and microscopy." 
In this paper Dr. Robinson, fresh from his studies in 
European medical centres, gave a masterly review of 
these subjects in a clear and orderly manner. 

During the meeting held December 12, 1899, the sec- 
tions on practice of medicine, gynaecology, surgery re- 
ported. The section on practice of medicine presented 
two reports — one by Dr. E. L. B. Godfrey, in a paper 
entitled ** Health condition of Camden city in respect to 
malaria and typhoid fever," and the other by Dr. John 
F. Leavit, entitled " Contagious diseases in Camden city.*' 

In Dr. Godfrey's report the attention of the members 
was directed to the fact that the city of Camden for some 
time past has been comparatively free from malaria and 
typhoid fever. From Dr. Leavitt's paper we find that 
during the past four and one-half years the city of Cam- 
den has had no cases of typhus fever or smal'-pox or 
Asiatic cholera ; also that only two cases of epidemic 
cerebro-spinal meningitis have been reported ; that 799 
cases of typhoid fever, with 83 deaths ; 72 cases of mem- 
branous croup, with 44 deaths ; 587 cases of scarlet fever, 
with 24 deaths; 831 cases of diphtheria, with 203 deaths. 
All these cases occurred during the past four and one- 
half years. 

The reporter for the section on gynaecology was Dr. 

H. H. Sherk, and the title of his paper was "Pruritus 
vulvae." This paper was listened to with much interest, 
and several points of value brought to the notice of the 
members. 

The reporter for the .section on surgery was Dr. Alex- 
ander McAlister, and his paper was entitled *' The present 
view of asepsis and antisepsis in general practice." This 
paper was an excellent one and was received with much 
approbation by the members. 



202 MEDICAL SOCIETY OF NEW JERSEY. 

During the meeting held February 13, 1900, the mem- 
bers listened to and were instructed by Prof. J. C. Wilson, 
of Jefferson Medical College, upon the subject, •* Ten 
years' experience in the treatment of enteric fever by 
systematic cold bathing, the method of Brandt." In this 
paper Professor Wilson directed the attention of the 
members to the result of the work of several physicians 
in Philadelphia in the Brandt treatment during the past 
ten years, 7,625 cases having been treated, with a mortal- 
ity of 7i per cent. The city of Philadelphia, with a 
record of 33,085 cases including the above, had a mortal- 
ity of 14 per cent. The bath is used whenever the tem- 
perature reaches 10 1^^^ and repeated. Contra-indications 
are hemorrhage or perforation. In severe cases the 
patient is lifted into the bath, but otherwise he is en- 
couraged to help himself even to the extent of walking, 
with the assistance of the nurse, to the tub. The practice 
of permitting the milder cases to walk to the tub has now 
been practiced at the German Hospital, Philadelphia, for 
more than three years. Professor Wilson believes that 
the few steps to and from the tub, taken every three or 
four hours, bring into play the muscles and thus relieve 
the tendency to passive congestion which is so marked in 
serious cases of typhoid fever. 

The meeting held May 8, 1900, was the regular business 
gathering of the year. The fore part of the meeting 
was given over to the dry reports of the retiring officials 
and the election of their successors. The latter part was 
devoted to eating an appetizing dinner and listening to 
after-dinner speeches. Among those who spoke were Dr. 
W. H. Iszard, who gave an interesting talk upon "Com- 
parative practice in the last quarter of the century;" 
also Dr. H. F. Palm, who, in a witty and sarcastic vein, 
presented a ** Pessimistic retrospect of medicine," and 



REPORTS OF DISTRICT SOCIETIES. 203 

also Dr. H. H. Sherk, who in a scholarly and refined 
manner, depicted the difference between " Country and 
city practice." 

2. A review of the work of the members during the 
past year, and a report of some interesting cases. 

Dr. W. H. Iszard, of Camden, reports that during the 
months of December and January as having an unusual 
number of cases of folicular tonsillitis, complicated with 
pharyngitis, and in many cases with a sequelae of puru- 
lent otorrhcea. Following this epidemic came the epi- 
<lemic of '4a grippe," commencing about the middle of 
February. This epidemic was accompanied with many 
cases of pneumonia which in many instances proved fatal, 
taking away a number of our most prominent young men, 
business men and valuable citizens. 

Dr. Paul Mecray, of Camden, reports five strangulated 
inguinal hernias in which he performed the Bazzini's 
operation, with no return as yet in any case. Also one 
case of extra uterine pregnancy; diagnosis made after 
rupture; operation and recovery. Also one case pros- 
tatic hypertrophy, with complete retention of urine ; 
<iouble costration resulted in recovery. 

Dr. Alexander McAlister, of Camden, writes that " in 
"October, 1899, I attended Mrs. W., a primipara, in con- 
finement. The child was born at full term, the labor an 
easy one ; nothing unusual had occurred during her preg- 
nancy. After ligating the cord, I discovered that the 
child had not only ecstrophy of the bladder but also two 
penpenes and two scrota. Both penpenes were located 
one on either side of the extroversion. They were de- 
void of foreskin, and no urethra was found in either one. 
Only one testicle could be found in each scrotum. The 
scrotums were attached to the lower border of the ex- 
troversion on either side. The urine escapes near the 



204 MEDICAL SOCIETY OF KEW JERSEY. 

medium line of the extroversion. This point is where 
the ureters are probably attached. The child up to this 
time is thriving." 

Dr. Joseph H.Wills, of Camden, desires to report a 
case of labor coming under his care, in which the woman 
insisted the time was up and wanted the confinement 
over. ** I put her off, saying she must have made a mis- 
take and it would turn out all right in time. The inter- 
esting part was that the movements had ceased, and I 
began to think I had a dead foetus to deal with. Three 
weeks went by and I had arranged on a certain day to 
have a consultation about bringing on labor. That 
morning she was taken in labor in Beverly, N. J., came 
down to Haddon avenue station on the cars and walked 
to Fifth and Federal streets for fear of betraying her 
condition by riding. And in an hour's time I delivered 
her of a fine living boy." 

Dr. John W. Marcy, of Merchantville, says that ** the 
most interesting case I have had lately is one of menin- 
gitis complicating typhoid fever in a child of ten years 
of age. It is still in progress and the outcome is yet in 
doubt, even though we are closing our fiftieth day." 

Dr. C. Hendry Shivers, of Haddonfield relates an ob- 
stetrical experience that occurred in his practice last July: 
** A primipara, aged 22; white; of the better class ; fine 
physique. Head presented normally and pains were 
average as to strength and frequency. She made con- 
tinual but very slow progress and was in labor forty hours. 
Gave her strychnine, quinine, beef tea, wine-whey and 
peptone at regular intervals through her labor. When 
the head reached 'the perineum I found she would tear,, 
and applied the forceps under ether to retard its progress. 
In spite of the best I could do she was torn laterally in 
both labia and backwards in the peritoneum. The cervix 



REPORTS OF DISTRICT SOCIETIES. 205 

Uteri was also torn into the body of the womb and she 
bled profusely. I pushed up to and held against the 
ruptured artery a towel wet with cider vinegar for two 
hours by the clock, completely controlling and perman- 
ently stopping the hemorrhage. On account of her 
exhausted condition, did not repair the laceration, but 
kept her in bed a month. The labial and perineal tears 
healed perfectly as if they had been stitched, and the 
cervical tear, though extended to uterine body, is in good 
condition. She had an uneventful recovery. The cause 
of her tedious labor and unfortunate tearing was the per- 
fectly ossified skull of the child. There was not even an 
anterior fontanelle as big as the little finger nail.** 

Dr. Alexander Marcy, of Riverton, writes as follows: 
^* As my location is such that only a bridge has to be 
c/ossed to be in Camden County, I feel at liberty to speak 
for Camden County. During the past year we have had 
nothing epidemic, but of course have had plenty of 
catarrhal disturbances of almost every character, from 
mild influenza to * grippe,* between which I make a sub- 
jective distinction, having been knocked out by the latter 
within the last four weeks and am still waiting to sweat 
it out when hot weather comes. It is certainly a " hold 
hard *' and does not like to let go. 

**We are unusually free from fevers of a severe type — 
I suppose because of our excellent supply of good water 
in the first place, for it comes from wells and not from 
the river. In the next place, every acre of ground in this 
neighborhood has been turned over from one to three 
times every year in the last fifty or sixty years, and the 
Plasmodium malariae don't get a good chance to do its 
work, nevertheless these fellows or something else get in 
a little work one way or another but are soon found out 
and squelched. There has been far more than the usual 



2o6 MEDICAL SOCIETY OF NEW TERSEY. 

amount of diphtheria this winter but no deaths; anti- 
toxine used in almost every case with satisfactory results. 
So far as my experience goes with this serum 1 am very 
well pleased, and only wish that some of the other serums- 
could prove themselves as well worthy of trial." 

Dr. C. G. Hoell, of Camden, says there has been in the 
city of Camden quite an epidemic of measles, also a great 
number of cases of croupous pneumonia. ** In my prac- 
tice I have seen more cases of pneumonia this winter 
than any previous time. Just at the present time have a 
few cases of diphtheria, and one severe case which imme- 
diately followed an attack of measles, which I never saw 
before in my whole experience. Bronchitis, pharyngitis, 
tonsillitis, laryngitis, have all been very prevalent in my 
practice this winter.** 

Dr. John Stevenson writes: "The past year in Had^ 
donfield and its vicinity has been one of average health. 
There has been no predominant disease among adults 
except * la grippe,* from which we were free until the 
middle of February. During March it became more 
prevalent than in any year since its appearance here in 
1890, but its type was not so violent as that of the first 
epidemic. From year to year this disease becomes a 
more interesting study. In no two out of the ten years 
that it has visited us have the symptoms been the same. 
This year nasal catarrh has been the most marked symp- 
tom, in some instances causing an abscess of the frontal 
sinus. The digestive organs have been more affected 
than the respiratory ones, causing anorexia, which did 
not disappear for some days after convalescence. The 
subsequent debility was less and of shorter duration than- 
usual. Pneumonia after * la grippe * was rare. In a for- 
mer paper I mentioned having seen cases contracted in* 
twenty- four hours after exposure to the contagion. This- 



REPORTS OF DISTRICT SOCIETIES. 20/ 

year some were clearly defined as occurring two days 
after infection. When bronchitis followed ia grippe' the 
most efficient remedy in my experience was heroin com- 
bined with turpin-hydrate. Among children rubeola has 
been very prevalent, but of a mild type. A few cases of 
scarlet fever have been noticed." 

Dr. H. Genet Taylor states that '* in my private prac- 
tice but little of interest has been presented except the 
usual diseases prevalent in our city during the past year. 
Pneumonia, bronchial and catarrhal affections with con- 
sequent sequelae were of more frequent occurrence, owing 
to the meteorological condition of the weather during the 
past winter months. The cases of pneumonia have been 
of unusual fatal type, the mortality very high and those 
met with in my practice involving the right lung, cardiac 
symptoms with lesions producing fatal results. The im- 
proved water system in Camden has almost ended the 
prevalence of typhoid fever, as reports from the Board of 
Health will show, only three or four cases having beer^ 
admitted to the Cooper Hospital during the past eight 
months, which in comparison with former years is a grati- 
fying report to make. 

*• Exanthematous diseases have been met with in my 
practice, particularly an epidemic of the so-called German 
measles, requiring but little treatment but guarding pa- 
tient for several days from exposure. Diphtheria, tonsil- 
litis and other diseases of throat have not prevailed to 
an unusual extent. The antitoxin treatment in diph- 
theria has fulfilled all requirements, and if used in the 
early stages of the disease has not disappointed the claims 
of the advocates of the serum treatment. I enclose 
some interesting cases treated at the Cooper Hospital 
prepared by Dr. Fithian, * interne physician,* at my 
request.*' 



208 MEDICAL SOCIETY OF NEW JERSEY. 

These cases are : a. Report of cases of acute articular 
rheumatism. These cases are interesting as pointing to 
the efficacy of the combined treatment of the alkalies 
and the salicylates in hastening recovery, b. Report of 
an interesting case of aneurism of the arch of the aorta. 
This case is instructive, as it furnishes more proof of the 
fact that aneurism does follow syphilis. This patient, 
with positive evidences of syphilis, had four different and 
distinct aneurisms. Two had been cured, another appar- 
ently giving no distress, and the fourth, by its growth 
interfering with the proper function of the lungs, caused 
death, c. Report of a case of foreign body in the oeso- 
phagus. This case is remarkable in that a piece of meat 
became so firmly wedged in the oesophagus that it re- 
mained there for over two weeks, notwithstanding the 
peristaltic movements of the oesophagus continued and 
other food was passed by it into the stomach during 
most of that time. 

a. Report of cases of acute articular rheumatism. Since 
January i, 1900, twelve cases of acute articular rheumat- 
ism have been treated in the wards of Cooper Hospital. 
The average duration of the disease under the combined 
treatment of the salicylates and the alkalies was eleven 
days. The duration of the disease in six cases was only 
seven days. In one case the duration was ten days, in 
another it was eleven days, and in two cases twelve days. 
In only one case was the duration of the disease over 
three weeks. In none of the cases was there any cardiac 
complication. All of the cases were given ten grains of 
the salicylate of sodium every two hours, and from twenty 
to thirty grains of the bi-carbonate of potassium every 
four hours. Six doses of the salicylate of sodium and 
three doses of the bi-carbonate of potassium were given 
in the twenty-four hours. The combined treatment was 



REPORTS OF DISTRICT SOCIETIES. 209 

kept up for several days after the subsidence of the in- 
flammatory symptoms. In all the cases but two the 
temperature had come down to normal and the pain had 
ceased at the expiration of forty-eight hours. Three of 
the cases were not admitted to the wards until after the 
disease had progressed for a short length of time, there- 
fore the average duration of the disease wou4d be some- 
what increased. The duration of the disease in those 
cases which were admitted to the wards after the disease 
had progressed for a length of time was noticeable longer 
than those cases in which the combined treatment was 
started at the beginning of the disease. 

b. Report of an interesting case of aneurism of the 
arch of the aorta. Patient, Charles White, colored, aged 
33 years, was admitted to Cooper Hospital January 2, 
1900. Patient, on admission to the wards of the hospital, 
complained of shortness of breath, substernal pain, dis- 
phagia and a feeling of constant suffocation. Patient 
gave a history of having been operated on in spring of 
1898 by Dr. John Ashurst for aneurism of left carotid 
artery, with resulting cure. In the fall of 1898 Dr. J. 
William White, at the University of Pennsylvania hos- 
pital, attempted to introduce a gold wire into a large 
aneurism of the aortic arch, 47^ centimetres in circumfer- 
ence. The aneurism of the arch of the aorta had devel- 
oped gradually since the spring of 1898, when the patient 
was operated on by Dr. John Ashurst. The attempt to 
introduce the gold wire proved unsuccessful because of 
the thickness and density of the aneurismal sack. Re- 
peated attempts were made to force the canula through 
the dense wall of the aneurism, much force being exerted. 
The patient gave a history of having then been put on 
the Tufnell treatment for six weeks, with resulting cure. 

In January, 1900, the large tumor, 47^ centimetres in 

14 



2IO MtDICAL SOCIETY OF NEW JERSEY 

circumference, representing the aneurismal sack of the 
aortic arch present in the fall of 1898, had entirely disap- 
peared. Patient felt no discomfort until October, 1899, 
when, after sudden exertion, he was suddenly taken with 
pain in the right side and back, followed by increasing 
shortness of breath. On examination of patient in Janu- 
ary, 1900, the heart was found enlarged downward and 
to the left; a loud systolic murmur was heard at the 
apex; heart's action rapid and irregular; right radial pulse 
was barely discernible. There was a distinct pulsation 
and thrill over the whole of the cardiac area. On admis- 
sion both lungs were found normal. A large quantity of 
albumen was found in the urine, also a trace of sugar. 
The first six days after admission the temperature ranged 
between 99° F. and 100° F. On" the seventh day the 
temperature went up to 102^ F. It declined gradually 
until the eleventh day and remained there until the six- 
teenth day, when the patient rapidly became cyanosed. 
the pulse feeble and rapid, and .the patient dying from 
failure of respiration. 

At no time while in the hospital was the patient able 
to swallow solid food. During the last two days the 
patient was unable to swallow liquids. Huskiness of the 
voice showed involvement of the motor nerves of the 
chords. A direct history of syphilis was obtainable and 
was verified by the post-mortem findings. At the post- 
mortem examination a beginning catarrhal consolidation 
was found in both lungs. The left ventricle of the heart 
was greatly enlarged. In the left auricle was found an 
aneurism the size of a hickory nut. The old sack of the 
aneurism of the transverse limb of the aortic arch was 
lined with an organized blood clot. At the position of 
the descending limb of the aortic arch was a large aneur- 
ismal sack about the size of a double fist which had 



REPORTS OF DISTRICT SOCIETIES. 211 

pushed its way over into the right chest wherCj it pressed 
on the right bronchus, greatly diminishing its lumen. 
The sack had completely surrounded the oesophagus, 
almost entirely obstructing it. The trachea was also 
pressed upon. Gumma were found both in the liver and 
kidney. 

c. Report of a case of foreign body in the oesophagus. 
The patient, a watchman, aged 75 years, came to the 
Cooper Hospital, giving a history of inability to swallow 
liquids or solids for two days previous to treatment and a 
gradually increasing dysphagia for about two weeks pre- 
vious. Patient was a large, robust German, well nour- 
ished. Patient complained of no pain, had lost no flesh, 
no history of hemorrhage, no tenderness on pressure; 
cancer was thus excluded. There were no symptoms 
pointing to aneurism of the arch or thoracic aorta. No 
specific history was obtainable nor was there any history 
of corrosion. Patient's breath was offensive. He com- 
plained only of hunger and thirst and also a feeling of 
constriction in the throat. Patient, after having been 
given a glass of water, made frequent attempts to swal- 
low, without result. On the passage of an oesophageal 
bougie the obstruction was located at about the position 
of the cricoid cartilage. A small sized bougie was forced 
through the obstruction, which gave the sensation like 
the tearing away of fibrous tissue. A subsequent attempt 
to pass a larger sized bougie met with failure. When an 
attempt was made to again pass the small sized bougie, 
the patient coughed, with the expulsion of a large piece 
of boiled meat about the length of the middle finger and 
the thickness of the ball of the thumb. After the expul- 
sion the patient was able to swallow liquids and solids 
without pain or difficulty. 

Dr. J. E. Hurff, of Blackwood, writes that *' during the 



212 MEDICAL SOCIETY OF NEW JERSEY. 

past year the prevailing diseases have been about the 
sanne as former years. Typhoid fever has been met with 
occasionally. Some few cases of diphtheria occurring in 
my practice. I always use antitoxin, with most gratify- 
ing results ; would not treat a case without it unless com- 
pelled to do so. One case of membranous croup fell 
into my hands — came from Atlantic City. It developed 
very suddenly. Antitoxin was used, with no result. As 
a last resort — the child dying — tracheotomy was per- 
formed. The relief was great, but child succumbed some 
thirty-six hours later. During the winter and spring 
months scarlet fever of- a very mild type, measles and 
whooping cough have been quite prevalent. In some 
localities the m'easles have been very severe, complicated 
with pnenmonia. *' La grippe " made its usual appear- 
ance, but much later than usual and, with but few excep- 
tions, much lighter in severity." 

3. In memoriam. Dillwyn Parrish Pancoast, M.D., 
born March 11, 1836; died November 4, 1899. Benjamin 
S. Lewis, M.D., born January 28, 1857; died March 9, 
1900. 

« 

4. The views of the members upon the question, ** To 
what extent does the charitable clinic curtail the revenue 
of the medical practitioner ?" 

Dr. Henry C. Shivers, of Haddonfield, views on the 
subject are that they tend to pauperize the people because 
they are absurd. ** It is quite the custom in my vicinity 
for well-to-do folks to inform me they visited the Wills 
Eye Hospital, of Philadelphia, and were treated for eye 
troubles and suited with glasses. Sometimes, also, I learn 
that people who live in quite a stylish manner frequent 
the hospital and college clinics. I am of the opinion 
that some of the fault lies with our specialists because of 
their prohibitive fees. Patients who cannot afford to pay 



REPORTS OF DISTRICT SOCIETIES. 21$ 

the great * Dr. X *. his consultation fee get his services 
gratis by visiting the hospital where he holds clinics. It 
seems to me there should be more moderate charges to 
suit people of moderate means.** 

Dr. John W. Marcy, of Merchantville, believes the dis- 
pensory service is good in idea, but is grossly abused, and 
to that extent a detriment to the physicians not con- 
nected with the institution. 

Dr. W. H. Iszard, of Camden, writes that charitable^ 
clinics curtail the revenue of medical practitioners fifty 
per cent. 

Dr. Charles S. Braddock, Jr., of Haddonfield, opinion 
after four years in the out-patient department of Jefferson 
Hospital, is that the charitable clinic to a great extent 
curtails the revenue of the medical man, many people 
coming to the diseases of children clinic who should 
employ and pay their medical advisors at home. **Many 
of these dress better than I can afford to.** 

An unsigned reply to the question, *' To what extent 
does the charitable clinic curtail the revenue of medical 
practitioners?'* More or less in the case of every physi- 
cian, but why need the right-minded physician care? 
He is not in this world to make money, but to cure the 
sick. All physicians, even those who believe in and act 
in accordance with the Code of Ethics, like to make 
money — ought to like it, but the main object of their 
life is not money, it is something better than money. 
A good soldier, for instance, mainly wishes to do his 
fighting well. He is glad of his pay, still his main notion 
of life is to win battles, not to be paid for winning them. 
So of the preacher. He likes his salary, but salary is not 
the main object of his life, The preacher*s object is to 
save souls, not to be paid for saving them. So of the 
physician. They like fees and justly grumble when they 



214 MEDICAL SOCIETY OF NKW JERSEY. 

are kept waiting for them, but the main object of their 
lives is not fees. They desire to cure the sick. They 
would rather cure their patient and lose their fee than 
kill him and get it. With the right-minded physician 
the cure is first and their fee second. 

Dr. H. F, Palm, of Camden, writes: **The multiplica- 
tion of free dispensaries and hospitals in all of our large 
cities has a debasing effect upon the population, and often 
the first step taken towards the alms house is by patron- 
izing a charitable clinic. It works a cruel wrong to the 
members of the medical profession whose legitimate 
revenue is seriously curtailed by the misused name of 
medical charity." 

Dr. Joseph H. Wills, of Camden, thinks "our practice 
is injured muc^i by free clinics, but they seem to be a 
necessary evil in order that the real poor may not suffer. 
We sometimes give to imposters in order that the needy 
poor may have their wants in a measure supplied." 

Dr. E. L. B. Godfrey, of Camden, says that during his 
association with the charitable work of the Cooper Hos- 
pital he has observed numerous instances in which pa- 
tients abundantly able to pay a physician have taken 
undue advantage of the charity of the hospital. 

Dr. C. G. Hoell, of Camden, states: '* As far as my 
practice is concerned it has amounted to considerable I 
remember when I first entered the medical profession it 
was a common thing to treat a fracture of the clavicle, 
arm or leg and to have cases of minor surgery, such as in- 
cised wounds of hand or arm, incised wounds of the scalp, 
removal of sebaceous cysts and other abnormal growths, 
etc., and obtain quite a little revenue from that source, 
but now things are entirely changed. Seldom are my 
services sought now in my practice for the above men- 
tioned cases. Patients of mine whom I have treated for 



REPORTS OF DISTRICT SOCIETIES. 215 

years now take advantage of the charitable clinic for any 
injury received or sickness incurred, and they are persons 
well able to pay for such services." 

Dr. Alexander McAlister. of Camden, writes: ** The 
extent to which free dispensaries curtail the revenue of 
the worthy practitioners is, in my opinion, not possible 
of estimation in dollars and cents. That these institu- 
tions do very materially and very wrongly hinder the 
progress of many an honorable young physician must be 
patent even to the common people. That the need, how- 
ever, for such institutions exists, and probably always 
will, does not bear denial. That a large percentage of 
their beneficiaries are persons with moderate if not fairly 
competent incomes will be shown by a little investigation. 
It may be that in the past, in the case of a goodly num- 
ber of these persons, adverse circumstances compelled 
the use of charity, but today this cause no longer exists 
while the practice is continued. Their external appear- 
ance and tale of woe on clinic occasions are studied, and 
therefore are not a proper criterion by which to judge of 
social and pecuniary circumstances. Other means must 
be employed. These persons need to be seen in their 
homes and upon holiday occasions. 

" Not all who crowd our free dispensaries are paupers. 
That's a capital fact to many of their beneficiaries whom 
nobody dares class as paupers, not even on dispensary 
days. The social functions are increasingly exacting but 
provide no free dispensaries. By the unbounded liberali- 
ties of the medical profession they are permitted to make 
multitudes of clinic day paupers and there is nothing 
strange about it all. Many men and women would cease 
to buy clothes if merchants gave them out gratuitously, 
or to buy bread if bakers opened free dispensaries, and 



2l6 MEDICAL SOCIETY OF NEW JERSEY. 

for precisel)^ the same reasons many will not buy medical 
advice. The result is that physicians* earnings are much 
curtailed.** 

Dr. J. E. Hurff, of Blackwood, says that the charitable 
clinic affects the revenue of physicians very much. " I 
believe that this charitable clinic does a great work for 
the poor, as intended, but then many take advantage of 
this free treatment instead of going to a private physi- 
cian. I believe that most of this work is done in our 
hospitals and in many instances recommended by the 
physician. For instance, the doctor has a patient and 
when consultation is needed, instead of calling in con- 
sultation at a cost to his patient, he sends him off to the 
hospital for examination, telling him it will not cost him 
anything. By so doing he continues to hold his patient. 
I believe that hundreds of cases are treated at the hos- 
pital that could afford to pay a physician at his home.*' 

Dr. Alexander Marcy, of Riverton, writes : " In regard 
to the question upon which our views are asked, I can 
only say this — so far as revenue to physicians is concerned, 
it makes little difference. Those who are too poor to pay 
anything are our Saviour's own legacy, * for the poor ye 
have with ye always,' and always will have. They can't 
pay ; that's all there is to it. Those who impose on free 
service are so mean and regardless of right and duty that 
they never will pay. So I look on these public dispens- 
aries of good to mankind, in a medical way, as a benefit 
to the profession as well as to the poor at large. Like 
everything else that God has given us for our good and 
comfort, there are always elements which can be made 
evil of, to the detriment of the good' intended. On the 
whole, I think the good done and relief given counts for 
more than the loss to the medical practitioners. Ours is 
not a business, it is a God-like profession. It is above 



REPORTS OF DISTRICT SOCIETIES. 21/ 

all and over all except the ministry of the gospel. Men 
may say what they may about a conscientious doctor — 
and I count none worth mentioning except the conscien- 
tious — they occupy a high place in men's hearts here, and 

I believe will be recognized hereafter." 

JOHN G. DORON. Reporter. 



CUMBERLAND COUNTY. 

To the Chairman of the Standing Committee, drc : 

The Cumberland County District Medical Society has 
had, as usual, four meetings during the year. The at- 
tendance has been fairly good. Let it be better. The 
discussion of papers and reports of cases is becoming 
more general, and is at all times both highly interesting 
and instructive. 

Our society shows its progressiveness in that the 
progress in the dififerent sections of medicine are to be 
presented during each year ; thus keeping the society in 
touch with the advancement along all lines of medicine 
and surgery. 

Dr. G. E. Day, of Millville, presented a carefully pre- 
pared paper entitled, " Rational Therapeutics." He made 
a strong plea for a more extensive use of alkaloidal medi 
cation, claiming, by this method of treatment, both safety 
and surety, as the alkaloids are always reliable and 
unchanging. Dr. Day also favored the society with an 
interesting paper on " Some eye cases." The paper and 
discussions brought out some valuable suggestions. 

A paper on ** Historical Reminiscences," by Dr. H. W. 
Elmer, of Bridgeton, covering a period of nearly thirty 
years, was presented in the writer's, usual interesting 
manner. 

Dr. E. S. Fogg, of Shiloh, reported the following case 
of ** cerebral hemorrhage:" Mr. B., age 16 years. On 



2l8 MEDICAL SOCIETY OF NEW JERSEY. 

morning of November 6, 1898, he arose about nine 
o'clock, and attended to some work ; and, about ten 
o'clock, went to a neighbor's. After being there a time, 
he asked the neighbor a peculiar question ; soon after- 
terwards he was seen vomiting, and then started for his 
home. While on the way, he again vomited, and after- 
ward fell to the ground in a partly conscious condition. 
He was removed to his home; and, in three-quarters of 
an hour from being taken ill, he was entirely unconscious, 
with death ensuing in about nine hours. Post-mortem 
revealed a large blood clot on posterior surface of medulla 
beneath pia, with both lateral ventricles filled with blood 
coming from ruptured vessels in the internal capsule. 
No evidence of meningitis, and no sclerosis of the vessels. 
The cause in this case seems to be obscure. His mother 
died of syphilis ; and, three months before death, he 
received a blow upon the head. No history that he was 
a "bleeder." 

The subject, *' Idiopathic tetanus," was presented by 
Dr. H. G. Miller, of Millville, in a paper reporting a case 

occuring in his practice. This paper elicited very general 

< 

discussion, and the prevailing opinion seemed to favor the 
non-occurrence of such a form of tetanus. 

Prof. H. A. Hare, of Philadelphia, favored the society 
with his presence at our annual meeting in April, and read 
an interesting paper on " Some Points in the Treatment 
of Typhoid Fever." He presented a striking array of 
statistics showing the lessened mortality of the disease. 
His presence and paper were highly appreciated. 

Another paper of very practical value was that read by 
Dr. T. B. Rogers, of Woodbury, on " The Relation of 
the Cow and her Products to Public Health." 

Dr. O. H. Adams, of Vineland, read a carefully pre- 
pared paper on " Serum Therapy." The paper was 



REPORTS OF DISTRICT SOCIETIES. 2IQ 

followed by some interesting and instructive discussion, 
showing the benefits to be derived from ** serum therapy,** 
both as a diognostic and curative agent. 

Dr. J. C. Applegate, of Bridgeton, reports an interest- 
ing surgical case from his hospital work, that of repairing 
a lacerated cervix, unilateral and double salpings, osphon- 
ectomy on a weak, anaemic and debilitated woman, with 
very gratifying results. 

Dr. H. W. Elmer, of Bridgeton, reports a case of 
rubeola in a lad of sixteen in his fourth attack. Mother 
had measles when pregnant with this child. Be this as it 
may, the fourth attack of measles in the same subject, is 
unquestionably out of the ordinary. 

Relative to the subject under discussion, ** To what 
extent does the charitable clinic curtail the revenue of 
medical practitoners?" The opinion seems to prevail 
that it does materially lessen the revenue of the prac- 
titioner. 

Dr. W. H. C. Smith: **That hospital clinics have 
largely diminished the legitimate revenue of the profes- 
sion is an undeniable fact." 

Dr. Jos. Tomlinson : "The clinic curtails to a very 
great extent the revenue of the general practitioners, and 
especially the younger members in the large cities.** 

Dr. H. W. Elmer: '* It does, undoubtedly, curtail to 
an unwarranted extent the revenue of the practitioner. 
He reports that as f6r Bridgeton Hospital, so far they 
will not tolerate a clinic." 

Dr. M. K. Elmer: ** It does curtail the revenue of the 
practioners very much in large cities where competition 
for material is great.'* 

Dr. Jos Sheppard : '* It seems to be true, that patients 
may and do impose on practitioners by getting gratuitous 
advice and treatment from hospitals and clinics, and that 
Xo a considerable extent.** 



220 MEDICAL SOCIETY OF NEW JERSEY. 

Those elected to active membership during the year 
are, Dr. G. L. Harker, of Port Morris ; Dr. Samuel Ben" 
nett, of Millville, and Dr. L. B. Phillips, of Deerfield. 

Death has invaded our ranks during the year, and 
taken from us one of our most devoted members, Dr 
Hamilton Mailly, of Bridgeton, who passed away on^ 
August 30, 1899. Tuberculosis cut short a life devoted 
to his profession. He served the society for several years 
as its secretary. He was, indeed, a painstaking official. 
Always courteous, he was admired by all. He was a 
physician of the noblest type, but he has obeyed the 
summons of the Great Physician, and is at rest. 

As to epidemics : No severe epidemic has visited the 
county. Rubeola seems to have been quite generally 
prevalent. Epidemics of mumps, scarlatina, chicken-pox^ 
impetigo and " la grippe " are reported. Altogether, 
our society has had a prosperous year. We are con- 
tinually adding to our numbers. Our aim and object is 
to be mutually helpful, and thus assist each other to- 

successfully combat disease. 

L. L. HAND. Reporter, 
Leesburg. N. J. 

ESSEX COUNTY. 

To the Chairman of the Standing Committee, &c,: 

The Essex County Society reports that during the past 
year nothing of great importance has occurred. The 
usual meeting of the County Society took place in April, 
transacting the necessary business of the year and elect-^ 
ing officers. Medical interest in the county is well 
sustained, the private medical societies adding very 
materially in its support with their monthly meetings^ 
discussions and social attractions. 

In Newark, the new City Hospital is slowly nearing 
completion, as is also a new wing to the Hospital of St- 



REPORTS OF DISTRICT SOCIETIES. 221 

Barnabas, which will add very much to each of these in- 
stitutions in increased room. In the lower portion of our 
city a new hospital — that of St. James* parish — has re- 
cently been opened, which will no doubt be of great use- 
fulness in a section which has long felt its need. 
. During the winter we were visited by quite an epidemic 
of influenza which brought with it an immense amount 
of work, with its complications increasing our death rate 
far beyond its normal figure, pneumonia of varied sorts 
being particularly, at fault. Measles has been Very preva- 
lent with us and, as usual, claimed more deaths than it 
should were the people more careful and considerate of 
its dangers. Early in the spring rotheln appeared and 
was very prevalent, but added but little to those who 
were its temporary victims. Typhoid fever has been 
scarce, but few cases having been recorded — a comment- 
ary on the winter of 1899 when we had such a fearful 
experience, as reported in my report of that year. 

I must express my regrets — that of receiving no reports 
of cases of interest to the State Society, the cause of 
which certainly can not be because of lack of material, so 
must be because of the absence of interest. 

The expression of opinion on the subject, ** To what 
extent does the charitable clinic curtail the revenue of 
medical practitioners," have been so scarce that if it were 
not for the notes of Drs. E. J. Ill, A. K. Baldwin and Theo. 
W. Corwin no report would have been noted of the re- 
quest of the State Society. 

My personal opinion on the subject is that as long as 
the clinic is run as at the present they are but breeding 
places for pauperism and fraud, and nowhere is this more 
evidenced than in our large manufacturing centre — New- 
ark. In my early days of practice in charge of one of 
these infamies it would make my blood boil to have to 



222 MEDICAL SOCIETY OF NEW JKRSEY. 

attend people who were able to buy me a thousand times, 
yet would they unblushingly accept or demand the well- 
meant charity for those who were so unfortunate as to 
need it. 

I have seen sealskin brush against shoddy and dia- 
monds flash in the sunlight of our out-door poor depart, 
ment, knowing well that the dollars robbed of the 
physician was transferred to their finger or bodice. 
I have seen carriages drive up to the door and its 
owner enter and demand a consultation of the whole 
staff of the hospital, with but the remark that the best 
doctors were in the hospital so he thought he would give 
us a call. The same man was ** bounced," if you will 
permit, but whose parting words were a promise to report 
the irate physician to the trustees. 

Here we have it in a nutshell — the lay members of the 
hospital. Here is the rock upon which we split. How 
lovelv to have thousands attend our clinics and how 
beautiful is the tabulated labor of the staff who are fools 
enough to do it. The servant of the lay member we 
have with us always ; they swarm like the locust of Egypt 
and our fee is sent to the old country to pay the freight 
on those who we will attend in our clinic next year — free. 

The charitable clinic is powerful for good but is poign- 
ant for evil. It is a condition which needs honest study 
and conscientious consideration — the broad sweep of the 
knife if found diseased, the soft touch of the finger if but 
weak. ** Whosoever will may come," but is there any 
more reason why we should cry our wares free while the 
lawyer and clergyman are paid and paid for all. Dante, 
with his powerful imagination, portrayed the varied types 
of depravity and their modified methods of punishment 
in his ** Inferno," but for the robber at our clinics I would 
go one better than he and consider that any part of hell 
would be too good for him. 



REPORTS OF DISTRICT SOCIETIES. 22J 

To what extent are we deorived? God alone knows. 
All I know is that I would that the day would come when 
we could separate God's deserving poor from the hounds 
who take from them the freely given service of any true 
physicians who are willing to give to those who deserve 
it, remembering the command of that Great Physician 
whose remarks should be graven upon our hearts: " In- 
asmuch as ye have done it to the least of my children ye 
have done it unto me." 

Dr. Edward J. Ill: "lam sure that the charitable 
clinic curtails the revenue of the medical practitioner, and 
it does so in direct proportion in which the attendant at 
the clinic neglects weeding out improper charitable cases. 
The greatest enemy, however, to the medical practitioner 
in this regard, is the non-medical authorities of the hos- 
pital and the so-called patrons." 

Dr. T. W. Corwin : " Your circular inquiry with regard 
to the influence of the charitable clinic, etc., at hand. 
When honestly conducted it does not greatly affect the 
revenue of the medical practitioner. The clinics are of im- 
mense benefit to the poor and indirectly, also, to the pub- 
lic. They also afford an appropriate and necessary school 
for practitioners. Much of the work done by them would 
otherwise either have to be done charitably by medical 
men individually, but a more considerable and very im- 
portant portion of it would be left altogether undone. 
So far as they are attended by people able to pay, it is 
fair to conclude that practitioners would individually be 
swindled to the same extent. Practice among dishonest 
people has little in it of a desirable character, in my opin- 
ion, and the individual doctor is usually, perhaps, well rid 
of such. When the promoters and supporters of the 
clinics, whether lay or medical, abuse its purposes much 
harm may follow. Such abuse could probably be limited 



224 MEDICAL SOCIETY OF NEW JERSEY. 

in part by general supervision, publicity, etc., but the 
millenium is not yet quite at hand.** 

W. S. DISBROW. Reporter, 



GLOUCESTER COUNTY. 

To the Chairman of the Standing Committee^ &c,: 

The usual interest has been manifested in the meetings 
of our society during the past year. The progress and 
prospects of the society are favorable and the numbers 
seem to show much interest in the work. A number of 
new members have been added to the roll during the 
year. Delegates from Camden, Salem and Cumberland 
Societies continue their visits to us and we are also fav- 
ored with the presence of noted specialists and general 
practitioners from Philadelphia, many of them reading 
interesting and instructive papers on various subjects. 

Dr. Lewis J. Lauterbach, of Philadelphia, read an essay, 
entitled "The prevention of deafness.*' Dr. G. Belton 
Massey, of Philadelphia, gave an interesting talk on **Mer- 
curic cataphoresis,** exhibiting the special needles and 
describing the major and minor methods of using the 
treatment. Dr. Daland read a paper on a case of " An- 
eurism of the heart ;'* he also gave a very interesting talk 
on fibroid changes in the heart and blood vessels. 

At the November meeting Dr. E. T. Oliphant. of Bridge- 
port, read an essay, entitled *' Ancient and modern medi- 
cine," which was exceedingly interesting. At the January 
meeting Dr. Wm. Brewer read an essay, entitled "Rheu- 
matism in childhood." At the March meeting Dr. C. 
Frank Fisler read an essay entitled ** Diphtheria,** which 
was very interesting and instructive. 

Epidemics of whooping-cough, chicken-pox, diphtheria, 
scarlet fever, " la grippe,'* measles, and pink eye were 
reported during the year. 



REPORTS OF DISTRICT SOCIETIES. 22$ 

Dr. Wilson, of Woodbury, reported a case of puerperal 
eclampsia. Patient had severe albuminuria and general 
anasarca, with almost complete suppression of urine during 
eighth month. So desperate did the case seem that the 
induction of premature labor had about been decided 
upon, when at the beginning of the ninth month labor 
occurred spontaneously. No trouble during labor, but six 
hours afterward severe convulsions came on. All the 
usual remedies were tried except bleeding, without result. 
Hypodermoclysis to the extent of eight pints was then 
tried, still without success. Intravenous injections of nor- 
mal saline solution were then given to the extent of four 
pints, and the patient finally rallied and improved very 
much, although albumin still persisted in the urine. Bleed- 
ing was not resorted to because the superficial veins were 
almost empty, and so it was thought to be contraindicated. 
A remarkable feature of the case was the very large 
amount of urine passed after the kidneys again began to 
secrete. Over two hundred ounces per day was passed 
for two days, then gradually dropping in amount, and 
now the patient has recovered and urine cleared up. 

Also a case of retention of urine. Woman was deliv- 
ered and had a fair recovery. Two weeks after labor the 
doctor was sent for. Patient had passed no urine for a 
day. Catheterization was done and eighty ounces of 
urine was withdrawn. 

Dr. Halsey, of Williamstown, reported a case of a man 
85 years of age, who said that he had passed no urine for 
four days. Catheterized him and withdrew five pints of 
urine. Also a case of puerperal convulsions in a woman 
in labor with her sixth child ; there was general anasarca ; 
bled her thirty-six ounces ; os was the size of a quarter 
dollar. He delivered her the next morning of a living 
child. The uterus did not contract after delivery and the 

15 



i 



226 



MEDICAL SOCIETY OF NEW JERSEY. 



hemorrhage was profuse, yet she made a good recovery. 
Also a case of pneumonia in a man aged forty. When he 
first saw him his temperature was 105.6^; respiration 50; 
nails blue; pulse 130; sputum rusty. He immediately 
bled him, taking twenty-eight ounces, which brought the 
temperature down to 101^ and respiration to 30. Patient 
rapidly became convalescent and recovered. 

Dr. Hunter, of Westville, reported a case of mitral re- 
gurgitation, with failure of compensation and cyanosis. 

Bled him thirty-two ounces, with excellent results. 

WILLIAM BREWER. Reporter. 
Woodbury. N. J. 



HUDSON COUNTY. 

To the Chairman of the Standing Committee^ &x: 

Several gentlemen, members of the Hudson County 
Medical Society, have kindly made efforts to help their 
reporter in presenting to you some of the interesting cases 
that have occurred in their hospital and private practice 
during the past year. 

Dr. J. R. Rosencranz, of this city, handed me this 
afternoon a record of two very interesting cases. 

Case i. — Hcemothorax : A man, 42 years of age, fell 
down a cellar stairs ; not realizing any injury, he attended 
to his regular business for some weeks, but complained, 
from time to time, of weakness. Two months after the 
injury he died. A few days before his death he grew 
pale, showing evidence of internal hemorrhage, had a 
pulse of 125, temperature rose to loo"". There was a 
dulness over the whole right lung, left lung normal, no 
tubercula bacilli in sputum, aspiration of right plerual 
cavity, pure blood. At the autopsy one gallon of pure 
blood was found in the right pleural cavity. No clots. 



REPORTS OF DISTRICT SOCIETIES. 22/ 

slight adhesions that break at lower part of right pleura ; 
right lung dark from compression, but floats in water, 
and apparently normal. Heart, liver, spleen, kidneys and 
stomach normal. 

Case 2. — A woman in her second pregnancy complained 
of pain in the lower part of her abdomen when standing, 
but was relieved by assuming a recumbent position. In 
the fifth month the pain became so intense she was chloro- 

* 

formed and a thorough examination made ; nothing ab- 
normal was discovered, however. At term she gave birth 
to a very poorly nourished child. The cord was found 
wound around the child's neck four times, with a very 
short piece between the neck and placenta, tying the child 
down in a fixed position. After the head emerged, be- 
fore the shoulders could be born, the cord had to be cut 
and tied to prevent its tearing. In all the cord measured 
four feet. The mother's pain had evidently been caused 
by the cord pulling, which was felt in the uterus. 

Dr. Talbot R. Chambers, of Jersey City, reports an 
unusual number of middle-ear and mastoid inflammations, 
he having a record of twenty-six Schwartzstake opera- 
tions, which were done with only three deaths. Two 
from tuberculosis, and one operated while in coma, failing 
to come out of his coma. He says most of the cases 
give history of recent attack of " la grippe " with throat 
complications. The disease evidently passing along the 
eustachian channel,, causes middle-ear disease. 

The following interesting and highly instructive case 
of retro-pharyngeal abscess in a child three months old 
was sent to me by Dr. John E. West, of Jersey City. 
The patient presented catarrhal symptoms, viz., Snuf- 
fles, slight cough, dyspncea and some elevation of tem- 
perature. The mother said the baby had taken cold 
three or four days previous. Some simple anti-cold 



228 MEDICAL SOCIETY OF NEW JERSEY. 

remedies were prescribed, and as there seemed to be 
considerable stenosis of the nares, the same was dilated 
with a bougie anointed with castor oil. This being 
repeated at proper intervals, relieved the nasal obstruc- 
tion, and made the patient breath easier. The child had 
also a catarrhal discharge from the left ear. Two days 
later the doctor was sent for in haste, the messenger 
stating the child was choking. He found all the 
symtoms enumerated above much aggravated, except the 
lasal obstruction. The dyspnoea was marked, and de- 
glutetion was difficult. The breathing was of a snorting 
nature, almost sterterous. The head was held back, 
mofuth open, and tongue partly protruded, a painful 
expression and cyanosis of the lips appeared. 

A hasty inspection and palpation of the throat re- 
vealed general oedema of all the structures of the phar- 
ynx and upper part of the larynx. Syrup of ipecac 
was administered with a view of relieving the throat 
and air passages of the accumulated mucous. This also 
gave some relief to the breathing, but it was only 
temporary. Dr. E. L. Bull being called in consulta- 
tion, Dr. West states, they concluded to perform 
intubation to prevent what they thought impended, viz., 
a closure of the larynx. In passing his finger, however, 
preparatory to introducing the tube, Dr. Bull discovered 
a retro-pharyngeal abscess. This being lanced and freely 
discharging, gave immediate relief. ' The little patient 
being very much exhausted, the after treatment consisted 
in supporting measures and stimulants. The nose, throat 
and ear were directed to be frequently syringed with a 
warm solution of boric acid. The case did well until the 
next morning, when a quite high temperature developed 
(103^ in the rectum) with marked prostration and symp- 
toms of septicemia. At 5 P. M., the rectal temperature 



REPORTS OF DISTRICT SOCIETIES. 229 

registered 105^. An ice-bag to the head and cold sponging 
of the body brought the temperature to 102^, nour- 
ishment and stimulants being pushed to the fullest extent. 
From this time the child continued to improve and made 
a good recovery. The doctor thinks this may have been 
caused by sceptic infection from the catarrhal inflamma- 
tion of the middle ear, which coexisted. 

Dr. Fred. M. Corwin, of Bayonne City, N. J., sends me 
an account of two cases of tetanus: 

"Two boys, C. B.'and J. W., both aged thirteen, shot 
themselves in much the same manner, on ulnar side of 
left hand, with blank cartridges from small pistols on 
Fourth of July. I happened to pass C. B., who was a 
patient of mine, on the street near my office, within a 
minute of the accident. Took him to office, cleansed 
wound and hand as well as I could without anaesthesia- 
This boy was naturally untidy, and his hands were very 
dirty with dust and smoke; Probe entered for an inch, 
but as its direction was clear of bone and tendon sheeths* 
I apprehended no trouble, rinsed it with bichloride, in- 
serted a wisp of gauze, and did it up in bichloride, gauze 
and cotton. He did not call on the sixth, as I told him 
to, so I left word at house, and his father brought him to 
office in evening. There was no discharge and no ten- 
derness, the wound being glued together. I opened it 
and noticed but a little serous discharge and no irrita- 
tion. 

On morning of eighth, he was at office early, say- 
ing hand and arm pained him. Hand was somewhat 
swollen, and there was an abundant discharge of a dark 
(stained) pus. I cleaned it well with syringe, using 
hydrogen, peroxide and plenty of rinsing, during which 
process, several bits of wad escaped. It now appeared to 
me to be granulating nicely, and in good condition for a 



230 MEDICAL SOCIETY OF NEW JERSEY. 

suppurating wound. On the tenth, the wound was very 
clean and healthy ; there was no swelling, scarcely any 
tenderness, and a slight discharge of unstained pus. At 
7 P.M, on the nth, his father came to me, saying the boy 
had taken cold in neck and back, he thought, by sleeping 
near an open window. Going at once to the house, I 
learned he had complained of pain and soreness of neck 
and throat at breakfast time, and had eaten but very 
little. He kept away from the house all day, however, at 
his usual amusements, even taking a swim in Newark Bay. 
I found him with spine erect and rigid, head slightly 
retracted on neck, and neck stiff and somewhat painful. 
Deglutition so difficult as to be practically impossible ; 
pulse full and bounding, temperature not taken by ther- 
mometer, but no increase apparent to hand. His father 
started immediately to New York for serum, returning at 
10 P. M., with a 20 c.c. bottle from New York Board of 
Health. 

** One-half of the bottle was injected into lumbar 
region, and a solution of chloral ordered. He was to 
have twenty grains by rectum every hour, unless sleeping 
soundly. At 5 A. M, on the twelfth, I saw him again. 
Had slept some, but chloral had not been used as directed 
on account of mother's unwillingness to annoy him, etc. 
I then injected the rest of serum, put thirty grains of 
chloral in solution into rectum, summoned ambulance, 
and removed him to hospital ; sent for more serum. At 
1 1. 1 5 A. M., jaws firmly locked, severe and painful spasms 
brought on by any irritation, and recurring every four or 
five minutes without external cause. He was anaesthet- 
ized, and smallest trephine we had, used to remove a 
button of bone from skull, about an inch and a half to 
left of median line, well to the front, and about one-third 
of a bottle of Gibier Institute serum slowly injected with 



REPORTS OF DISTRICT SOCIETIES. 23 1 

a hypodermic syringe, the same being filled twice, and 
needle introduced in two different directions. The orig- 
inal wound of hand was laid open by a free incision, a 
part of the wad being found there, and the new and old 
wound, after thorough washing, was swabbed with strong 
tincture of iodine. During anaesthesia, and for about an 
hour afterwards, there were no convulsions, but from that 
time on, they were of frequent occurence. At 5 P. M., 
under chloroform, another bottle of serum (about 25 c.c.) 
was injected subcutaneously, but without apparent effect. 
He died at 7 P. M., asphyxiated. He had an eighth of a 
grain of morphine hypodermically at 10 A. M. and at 4 
P. M., to relieve pain to some extent, and liquid nourish- 
ment, and some chloral by rectum during the day. 

** The second case, J. W., was admitted to the Bayonne 
Hospital, where I first saw him July 13, at 8 P. M., with 
a similar history of shooting himself on the fourth, and 
having had some tetanic symtoms beginning on the 
eleventh. His case seemed somewhat less rapid than the 
first. As soon as it could be obtained, 25 c.c. of Gibier 
Institute serum were injected subcutaneously under 
chloroform anaesthesia and at same time a tube was 
passed through nose and pharynx to stomach, and a pint 
of peptonized milk with one ounce of whiskey poured 
through it. This treatment was repeated every six hours» 
the boy's condition remaining the same as on admis- 
sion, and it seemed as if his case was somewhat more 
hopeful than the first, but at 11.45, on the fourteenth, 
about twenty-eight hours after coming under my observa- 
tion, he died in a convulsion. He had no inbra-cerebral 
injection. 

" In presenting these cases to the Union County 
Medical Society at its meeting, in October, 1899, I 
reviewed the reports of all the cases I could find reported 



232 MEDICAL gOCIETY OF NEW JERSEY. 

in the journals up to that time, and concluded my report 
with the following summary : If these two cases are com- 
pared with the ones above described as being successfully 
treated by intra-cerebral or hypodematic injections of 
anti-toxine, it will be seen that they were much more 
severe and rapid in their course, in fact, dying in less time 
than was required to establish the diagnosis in some of 
the cases. Looking back, then, over the histories which 
I have found, and counting my own case, we have twenty 
cases treated by intra-cerebral injections, of which ten 
have recovered and ten died. Of the ten which recovered 
there are six in which the period of invasion of the tetanic 
symptoms is noted, and the periods were, 14, 12, 9, 12, 
ID and 7 days respectively, and in the ten cases, the in- 
tra-cerebral injections were made at periods varying from 
one to nine days after the invasion of symptoms, one 
being 9, one 7, one 5, one 4, one 3, two 2, and in only one 
case was the injection made the day after the onset of the 
symptoms. Of six fatal cases in which periods of inva- 
sion are noted, they were, 13, 8, 7, 7, 6 and 6 days, and an 
average of less than eight, as against ten and a half days 
in the others, and these cases all died in from one to three 
days after the invasion, so the injections mxist have been 
used much more promptly than in the recovering cases; 
thus it would seem that the prognosis still depends, as in 
the ante-antitoxine days, upon the time which elapses 
before the invasion of the tetanic symptoms. Much 
speculation was indulged in last July, as to why there were 
so many more cases in and about New York than ever 
before. My own opinion on that subject is this : Most 
cases occurred from wounds inflicted by the wads of 
blank cartridges which, with the cheap pistols for firing 
them, seem to have been very fashionable with the 
patriotic young American on the last fourth. Bacteri- 



REPORTS OF DISTRICT SOCIETIES. 233 

ology tells us that the dust of our thoroughfares is 
profusely supplied with the tetanus bacilli during the 
warm months, consequently the wad of the blank cart- 
ridge entering the tissues of a dirty hand introduces an 
abundant supply. A bullet would go way through the 
hand and take many of the bacilli with it ; at all events, 
it would afford much better opportunity for thorough 
washing and drainage, but the wad deposits its burden of 
dirt and bacilli under the skin ; perhaps, in the fibres of 
the muscles, an especially favorable place for the bacilli, 
and the exuding serum forms a splendid culture medium. 
It may be that the wad or the mucilage which is used in 
holding the different layers of it together, furnishes some 
substance which is also favorable to the development of 
the germs. The wounds are not usually considered 
severe, so do not receive the radical treatment they 
deserve. The next time, and in every time hereafter, 
such an injury comes under my observation, I mean to 
anaesthize patient, open up the wound, thoroughly remove 
all traces of the wad, and curette and cut away all bruised 
and discolored tissues along the track of same, thus insur- 
ing the thorough removal of all dirt and bacilli, irrigate 
thoroughly and provide for drainage. I believe that such 
a procedure would prevent such prevalence of tetanus as 
we had last July, and I would strongly urge all who may 
see such cases to adopt it." 

To what extent does the charitable clinic curtail the 
revenues of the medical practioners? 

Dr. Fred M. Corwin thinks it depends greatly on loca- 
tion and environment. He says, in Bayonne, taking 
account of all the cases which go to the neighboring 
cities to see the professor, about five to ten per centum. 

Dr. J. H. Rosencranz says it is hard to estimate how 
much one's revenue is curtailed by the charitable clinic, 



234 MEDICAL SOCIETY OF NEW JERSEY. 

but by comparing the country doctor, where there are no 
clinics, with the city doctor, who has the clinics, one may 
approximate the loss. Country doctors have as much to 
do and receive as much remuneration for an equal num- 
ber of inhabitants as the city practitioners doing the same 
general practice. The city has more sickness and acci- 
dents and less money proportionately paid to medical 
men doing general practice. The clinic should only treat 
paupers. 

Dr. Talbot R. Chambers says there are many people in 
Hudson County abundantly able to pay a physician, who 
cross the river and pose in the free dispensaries there as 
mendicants. They obtain treatment and are operated on 
without cost to themselves. Some of them boast how they 
need not pay, and leave our clinics in Jersey City, where 
free treatment is refused to such, for the New York clinics. 
No worthy person is refused treatment or operation in 
Jersey City clinics, and the men in charge are just as 
competent and attentive as the New York men. 

During the past year our society has lost two distin- 
guished members by death — viz. : Dr. F. E. Noble and 
Dr. John J. Cunneely. 

There is a spirit of true scientific feeling manifest 
among our members, and we expect to have some inter 
esting papers read at our next meeting after the summer 
vacation. At our annual meeting in May, several new 
members were elected, and I am happy to be able to 
report that our society is in a good, healthy condition, 
financially and fraternally. 

H. H. BURNETTE, M.D., Reporter, 
HOBOKEN, N. J., June 7, 1900. 



REPORTS OF DISTRICT SOCIETIES. 235 

MERCER COUNTY. 

To the Chairman of the Standing Committee ^ &€.: 

Well attended meetings and an unusual amount of 
interest has been shown throughout the year. The soci- 
ety is in a flourishing condition, having increased its 
membership by six. Many instructive and interesting 
papers were presented during the year, and the discus- 
sions arising only increased their value and usefulness. 
At the annual banquet held November 14, 1899, twenty- 
eight members and their invited guests sat down to an 
elaborately prepared menu. The guest of honor was 
Prof. James Tyson, of the University of Pennsylvania, 
who read a carefully prepared and highly instructive paper 
on ** The relations of heart and kidney disease.'* 

In the death of Dr. Lloyd Wilbur, of Hightstown, N. J., 
which occurred January 27, 1900, the society was called 
to mourn the death of one of its oldest and most highly 
respected members. • 

During the past winter, there was rather an unprece- 
dented amount of illness in Trenton and vicinity. The 
extreme prevalence of **la grippe," rheumatism, tonsil- 
itis, etc., are to be ascribed to climatic conditions, the 
weather man having been pleased to furnish us weather 
having many vagaries and varieties in the same day, all 
of which tended to a high mortality in the extremes of 
life, there being an unusually large number of persons in 
advanced life succumbing 

At our three eleemosynary institutions, St. Francis' 
Hospital, the Mercer Hospital, and the Trenton Eye and 
Ear Infirmary, much good has been accomplished. 

*An outbreak of typhoid fever occurred the past winter 

*January, igoo^New cases typhoid, 45 ; deaths, 9 February, 1900 — New 
cases typhoid, i ; deaths, i. 



236 MEDICAL SOCIETY OF NEW JERSEY. 

and for a time caused great alarm, as the recent Philadel- 
phia epidemic had not yet been forgotten. During one 
week there were upwards of twenty new cases, and as the 
majority of these occurred in one locality the new reser- 
voir was thought to be the cause, but it was later clearly 
settled that the Delaware river, which receives the sew- 
age of a number of towns, was the predisposing cause. 
The nature of the rock formation underlying the city of 
Trenton, precludes the possibility of artesian wells ever 
being in general use. As filtration of a public water 
supply removes a large number of disease germs a move- 
ment has been started to investigate the merits of the 
system. 

Dr. Wm. A. Clark presented an able paper on ** Some 
cases of pleurisy with effusion," which was discussed by 
Drs. McGalliard, C. Shepherd, Costill, Stevenson, Adams, 
Armstrong and Barwis. 

Dr. George Schoning read a paper, entitled **The 
medical practitioner in Germany." He said: "The pre- 
paratory education is the same for all scientific courses 
and is obligatory. At 18 or 19 students leave the gym- 
nasia, where they have had thorough instruction in 
Latin, Greek, French and German, and take the govern- 
ment examination for scientific courses. If successful, 
and only about half of the candidates are, the student 
may now attend any of the universities. The medical 
student spends two years in botany and other preparatory 
studies, and then comes the real course in medicine which 
takes three years more. Now, after five years, he may 
present himself to the government examiners. These 
examinations are thorough and require several months — 
each department takes about a week. A case is given 
and must be reported on. License is then given to the 
successful ones. 



REPORTS OF DISTRICT SOCIETIES. 237 

** Some enter practice at once, others seek hospital ex- 
perience before taking up the responsibilities of private 
practice. Confinement cases are attended by midwives, 
who are licensed and obligated to call in a physician in 
difficult cases. Fees in the cities are about forty cents of 
our currency, but the cheaper cost of living offsets the dif- 
ference. Evening office hours are not customary. Each 
district has a physician whose duties are somewhat 
similar to those of the county physician and health offi- 
cers here. Among other things, he is charged with seeing 
that all practitioners within his territory are legally quali- 
fied. Contagious diseases are reported but not placarded 
— the children of such families are kept from school. 

** The medical societies hold monthly social and scien- 
tific meetings from which absentation is not permitted 
except under peculiar circumstances. All cases of dis- 
pute within the profession are settled by the society. No 
sick benefit association arrangements can be made with- 
out sanction of society. Physicians sick or out of town 
cannot leave their practice in charge of a single colleague, 
but all must be notified and report on return of principal.** 

Dr. C. Shepherd reported a case of cigarette poisoning 
after smoking fifteen or twenty cigarettes in succession. 
Patient was found unconscious, congested face, blue 
hands, etc. 

Dr. William A. Clark's paper on " The abortive treat- 
ment of acute lobar pneumonia, with report of cases/* 
was well received. Sodium salicilate in twenty grain 
doses every two hours until the patient was fairly drunk 
with it, was urged to be used, by the author, as a specific. 

Dr. B. W. McGalliard read a paper, entitled " Some 
points in the etiology of malarial fever.** 

Dr. C. F. Adams read a paper on ** Tuberculosis,*' in 
which he urged that steps might be soon taken for isola- 



238 MEDICAL SOCIETV OF NEW JERSEY. 

tion and disinfection of excreta, etc., of persons affected 
with the dread disease. Renovation of homes occupied 
by tuberculous patients was hoped for and a proper place 
to care for patients outside of the already overcrowded 
hospitals. 

As no replies were received to the question, **To what 
extent does the charitable clinic curtail the revenue of 
medical practitioners?" it is evident the subject has not 
been given due thought. 

Dr. C. Shepherd writes: ** In one of my cases of 
typhoid fever, about the close of the fourth week of the 
disease, supperative process of the bladder developed and 
a large amount of pus passed with his urine. Under the 
use of urotropin, ten grain doses three a day, the urine 
cleared up, the pain and difficulty of urinating subsided, 
the temperature became normal and he made a rapid re- 
covery. In another case of typhoid fever, under the use 
of quinine and acetanilid with cold sponging, the tem- 
perature would range from 101° in the morning to 105^ 
in the evening, but on dropping the quinine and acetanilid 
and substituting thermol in five grain doses every three 
hours the temperature remained between normal and 
102^ during the fever, which subsided at the close of the 
third week. The case ran a mild course, the blood exam- 
ination showed typhoid reaction. The thermol had no 
accumulative or unpleasant effect, and as the disease ran 
a very satisfactory course under its influence, I recom- 
mend its use and will give it further trial in similar cases 
as opportunity is afforded." 

Respectfully submitted, 

J. FRANKLIN CHATTIN, Reporter, 



REPORTS OF DISTRICT SOCIETIES. 239 

MONMOUTH COUNTY. 

To the Chairman of the Standing Committee^ &c»: 

Answers to requests for descriptions of interesting cases 
were a minus quantity, as but two or three replies were 
received to the forms sent to each member of the district 
society, and these simply acknowledged the receipt of 
the forms. 

At our district society meeting, held at Freehold, May 
2 1st, Dr. Forman presented a case of partial resection of 
the left superior maxilla for cancerous growth, with den- 
tal work by Dr. Truax, D.D.S., for repair of masticating 
qualities and for cosmetic effect, both of which were 
perfect as far as appearance and the testimony of the 
patient goes. 

Dr. Field, of Red Bank, reported an epidemic of small- 
pox whose origin was traced to Norfolk, Va., which first 
showed itself at Seabright, this State, where a total of 
fifteen cases occurred, and also at Long. Branch where 
nine cases developed. The last case was isolated within 
four weeks of the beginning of the outbreak. Some dis- 
cussion took place as to the relative merits of the glyccr- 
inated vaccine tubes and the older ivory points in* which 
the tubes had rather the best of the argument. Dr. Field 
also reported a case of laceration of the scalp in which 
symptoms of tetanus developed within one week of the 
original injury, and in which he had injected anti-tetanic 
serum within fifteen hours and in which the patient^had 
died within sixty hours of the first appearance of symp- 
toms of tetanus. 

Ex Governor Newell was present and Fgave a short 
reminiscent speech in answer to his nomination to honor- 
ary membership in this district society, which he first 
joined in 1840, the year after his graduation in medicine. 

W. U. KURTZ. Reporter, 



240 MEDICAL SOCIETY OF NEW JERSEY. 

MORRIS COUNTY. 

To the Chairman of the Standing Committee^ &c,: 

The reporter has received absolutely nothing upon 
which to base a report as to the general health of the 
county. He is able to state, however, that the interest 
in the meetings and proceedings of the society, as such, 
shows no abatement, the meetings being well attended 
and thoroughly enjoyed. 

At the annual meeting in May, the following papers 
were read : " Pleurisy with effusion," by Dr. Walters, 
the retiring president ; **Autoinfection," by Dr. Griswold. 
Both these essays were well received and thoroughly dis- 
cussed. Interesting clinical histories were also given by 
Kice, Flagge, Henriques and Foster. 

Dr. John Stiger, of Mendham, who has held the posi- 
tion of treasurer of the society in a most acceptable 
manner for many years, has felt compelled to resign his 
office in consequence of impaired health. A resolution 
was passed at the last meeting conveying to him the 
society's regrets at the circumstances which made neces- 
sary his resignation, and expressing the hope that he 
might soon be restored to health and his life spared for 

many years to come. 

E. P. COOPER, Reporter. 



PASSAIC COUNTY. 



To the Chairman of the Standing Committee, &c,: 

It appears that the number of cases requiring intuba- 
tion for diphtheritic laryngeal stenosis during the past 
year has been less than in previous years, and that the 
question is not decided whether this was due to a change 
in the type of the disease or due to the early use of anti- 



REPORTS OF DISTRICT SOCIETIES. 24I 

toxin. However, from good authority here it is reported 
that the percentage of recoveries from diphtheria after 
intubation has been doubled in those cases which received 
antitoxin treatment. 

The Passaic County Medical Society has interested 
itself earnestly in the improved construction of school 
houses, both in regard to the buildings and as to the 
heating, lighting and the ventilation ; and the work of 
^ the committee, consisting of Drs. W. B. Johnson, William 
K. Newton and Frank E. Agnew, appointed by the Pas- 
saic County Medical Society, has resulted by their inter- 
views with the board of education, in their being partially 
instrumental in effecting the construction of as well built, 
lighted and ventilated a school house as there is in the 
State of New Jersey, namely, Public School No. 3, of 
Paterson. 

This ** Committee on School Hygiene'* of the medical 
society believes that the matter of school house construc- 
tion will be hereafter considered from a different point of 
view and to greater benefit for the pupils than ever 
before, and in Paterson an appropriation of $100,000 has 
been made for increasing the facilities in and improving 
the condition^ of the public schools. 

Our hospitals, the Paterson General and St. Joseph's, 
are continuing a vast work in this city, their capacity 
being tested to the utmost. Dr. J. L. Leal reports from 
the General Hospital the completion of the " Graham 
Memorial Operating Pavilion," a new building added by 
means of the Graham legacy, and that this is now ready 
for use, being constructed on the most approved designs 
for perfect sterilization and maintenance of practical 
asepsis, as well as modern operating facilities. 

The following-named changes have been made on the 
stafif of this hospital: Dr. James M. Stuart has been 

16 



242 MEDICAL SOCIETY OF NEW JERSEY. 

appointed in place of Dr. Alexander W. Rogers, resigned, 
and who had served as attending physician since the 
organization of the hospital under the former name of 
"The Ladies' Hospital of Paterson.'* Dr. John R. Mer- 
rill has been appointed in place of Dr. Cornelius Van 
Riper, resigned. The positions of Drs. Stewart and 
Merrill on the outpatient stafiF have been filled by the 
appointment of Drs. Joseph W. Williams and Dr. John 
C. McCoy. 

At St. Joseph's Hospital the out-patient department 
has been discontinued for some time past. Dr. Andrew 
F. McBride has been added to the staff of the hospital 
on the medical division, and Dr. Henry Parke has been 
elected associate in gynaecology with Dr. George H. 
Balleray. 

The Paterson Eye and Ear Infirmary has been doing 
good work, and rather more than the usual number of 
patients have been treated there under the care of Dr. 
W. B. Johnson and his newly appointed assistant, Dr. 
James W. Atkinson. 

In Passaic city, the General Hospital has a large service 
and is doing a good work. In the same city St. Mary's 
Hospital, in consequence of internal dissentions, has 
passed from the hands of the regular school physicians 
and is now controlled by a newly appointed staff of 
homoeopathic physicians. 

The Paterson City Isolation Hospital for contagious 
and infectious diseases, recently added to our quarantine 
and hospital facilities, has proved itself to be in hundreds 
of cases that such a hospital is absolutely a necessity as 
a practical part of a well and successfully conducted 
health department. Also it has proved to be the salva- 
tion of the community from the possibilities of the 
most dread cases of infectious and contagious diseases, 



REPORTS OF DISTRICT SOCIETIES. 243 

resulting in such instances in a minimum of danger to 
the city and in a maximum of safety and comfort to the 
patient. This isolation hospital has been selected by the 
American Committee of Hygiene at the Paris Exposition 
of 1900, as the model isolation hospital for plans and 
illustrations, to represent this country's progress in that 
department of public hygiene through health boards. 

The Health Board of Paterson, among other advances, 
continues the use of formaldehyde in place of sulphur- 
ous method of fumigation very commendably, as we 
believe the efficiency of formalin in general fumigation 
to be thoroughly established. 

The Paterson Board of Health has lost its well appreci- 
ated, active and progressive worker in matters of public 
health, Dr. John L. Leal, who had spent many years of 
service as health officer and who was the prime mover in 
most of the recent aggressive movements and acquisitions 
of authority and facilities vested in this body. Early in 
this year his successor. Dr. B. C. Magennis, entered the 
duties as health officer. 

The board reports no st'vere epidemics, with the excep- 
tion of one of diphtheria, which started about the time 
of the opening of the schools in September, 1899, which 
died out only to be repeated, though as a milder epidemic, 
after the opening of schools after the winter holiday 
recess. The number of cases of diphtheria reported for 
that season were : 

1899 NO. CASES I9CX) NO. CASES 

August 24 January 88 

September 37 February 32 

October 83 March 57 

November 90 April 29 

December 121 

The Board of Health has met with the cooperation of 
the East Jersey Water Company and has succeeded in 



244 MEDICAL SOCIETY OF NEW JERSEY. 

removing many sources of pollution of the waters of the 
Passaic river and its tributaries, and thus have protected 
the water supply of several cities from contaminations 
both of animal matter and other evils, so that water is 
supplied to the cities dependent thereon practically direct 
and unchanged from the mountain districts. When some 
more improved method of filtration is found for water in- 
takes, there will also be removed another factor which 
remains incidentally of some considerable unpleasantness, 
namely, the discoloration and frequent muddiness of an 
otherwise very safe water for household use. 

The greatest change in Paterson's water supply took 
place in December, 1899, when the intake at the Great 
Falls, or Passaic Falls, within city limits, was discontinued 
and the new supply was begun at once from the intake 
about five miles up stream, at Little Falls. Since then, 
according to the Board of Health reports, the number of 
cases of typhoid fever has been reduced to a minimum. 

In X-ray work we have report from Dr. Joseph W. 
Williams of many successful and beneficial instances of 
the use of both the fiuoroscope and the radiograph, not 
only in emergency cases of foreign bodies requiring quick 
operation, but also in other surgical cases needing accu- 
rate observation and diagnosis In our opinion there is 
no doubt of the desirability and the probable requisition 
in the near future that every well equipped hospital shall 
have access easily, if not witnin its walls, an X-ray appar- 
atus. 

In electro-therapeutics of the eye, Dr. W. B. Johnson 
reports the most marked progress of the year to be the 
magnetic probe's speedy removal of foreign metallic 
bodies and application, also, of that probe for the same 
purpose in other parts of the body. 

Dr. William Flitcroft reports a case of rupture of 



REPORTS OF DISTRICT SOCIETIES. 245 

uterus, at the seventh month stage of gestation, having 
no important history except a previous trachelorrhaphy 
by himself. 

Drs. Calvin Terriberry and James W. Smith report the 
removal by gastrotomy of foreign body in the oesophagus 
(of a patient calling himself a sword swallower), namely, 
a black hard rubber beer scraper 10 inches long, f inch 
wide and \ inch thick, which had lain in the oesophagus 
over two days and which was found protruding into the 
stomach about two inches. 

Dr. Francis H. Todd reports a case of perforation of 
the stomach, patient being a woman, while she was about 
her household duties and during no violent action ; but 
merely as she was rising from a stooping to erect posture 
she felt something give way in that region. Autopsy 
showed perforation of the stomach. 

Two of our number have passed away in the past 
year. Dr. A. D. Jousset, while in attendance upon his 
professional duties to a case of diphtheria, was himself 
infected by the disease, which was fatal after a few days* 
illness. He had been very active in practice of his pro- 
tession in Paterson for about seventeen years. 

Dr. Dillon Drake, after practicing in Paterson and 
vicinity for about six years, succumbed to the inroads 
and secondary effects of multiple arthritis deformans. 
He was energetic to the last. 

The society upholds the Code of Ethics, and we learn 
that the Passaic City Medical Society of regular school 
physicians has excluded one of its members on the basis 
of unethical consultation. 

The Passaic County District Medical Society has held 
its monthly meetings regularly. Very important papers 
have been presented and their influence has extended 
practically to the benefit of the community, as well as 



246 MEDICAL SOCIETY OF NEW JERSEY. 

to the scientific advantages for the hearers in the society. 
This society has shown its appreciation of the efforts of 
the president. Dr. James M. Stewart, during the past 
year, and having no better way at comniand gave him 
the honor of reelection at the annual meeting in April, 
and we are looking forward to a very useful and instruct- 
ive series of meetings for this year. 

JOHN R. MERRILL. M.D.. Reporter. 
Paterson, N. J., June, 1900. 



SOMERSET COUNTY. 

To the Chairman of the Standuig Committee, Gfc, : 

The meetings of our Society have been well attended, 
and have proven profitable both professionally and soci- 
ally. At the October meeting, Dr. W. H. Merrill, of 
South Branch, read a very interesting and instructive 
paper upon ** The management of the third stage of 
labor." At the January meeting Dr. J. P. Hecht, of 
Raritan, led the discussion upon the subject of ** the 
protection of the perineum during labor." Many useful 
points were brought out. At the annual meeting in 
April,. Dr. E. J. Ill, of Newark, gave the annual address 
upon the subject, ** Causes, diagnosis and surgical treat- 
ment of pelvic inflamation." This was followed by the 
election of officers for the ensuing year, and the annual 
banquet. 

During the year the Society has lost one member by 
death; Dr. Irwin Fisher, of Harlingen, who died sud- 
denly, December 31st, from valvular disease of the heart. 
He was a young man of undoubted ability, of promise in 
his profession, and one whom the Society will miss greatly 
from its number. One new member has been received, 
Dr. M. C. Smalley, of Gladstone. At the January meet- 



REPORTS OF DISTRICT SOCIETIES. 247 

ing, Dr. J. p. Hecht presented the Society with an 
unbroken file of the New'York Medical Record Irom 1884 
to 1899, to ^^ bound and kept in a public place, accessible 
to the members of the Society. No cases of especial 
interest have been reported. Measles and whooping- 
cough have been very prevalent throughout the county, 
and there have been a number of cases of scarlet fever, 

mostly of a mild type. 

J. HERVEY BUCHANAN, Reporter. 

North Plainfield, N. J., May 16, 1900. 



UNION COUNTY. 



To the Chairman of the Standing Committee^ &c. : 

I would report, for Union County, an active interest in 
the progress of medical science, as evidenced by well- 
attended and interesting meetings of the County Society. 

The usual amount of contagious sickness has been 
reported, except in the case of typhoid fever, which has 
been extremely rare. Measles is very prevalent, and 
quite severe in character. The ** grippe*' epidemic of 
March and April was especially fatal to the aged, as 
pneumonia was a common complication. 

The attempt to establish a county insane institution 
has been met by the united opposition of almost all of 
the physicians of the county, and nothing definite has 
been done as yet. 

The County Society has lost, by death, one member, 
Dr. T. J. Jackson, of Springfield. New members elected, 
one. 

The papers read and discussed at the four regular 
meetings of the Society, were as follows : 



248 MEDICAL SOCIETY OF NEW JERSEY 

** Puerperal fever," Dr. Jas. S. Green ; " Hypnotism," 

Dr. T. F. Livengood; *' Anti-toxine treatment of 

tetanus," Dr. T. W. Corwin ; ** Headaches," Dr. Norton 

L. Wilson. 

Respectfully submitted, 

R. B. WHITEHEAD, Reporter, 
Elizabeth, N. J.. May 7. 1900. 



WARREN COUNTY. 

To the Chairman of the Standing Committee y &c. : 

I received in due time my portion of your notices and 
requests sent to the different reporters of the district 
medical societies throughout the State, and forwarded 
same to the members of our County Society, but have 
met with very little success in the form of answers to the 
queries. 

There are no private or public hospitals in Warren 
County, except what is known as the poor or county 
house for paupers; and, of course, this institution is 
more beneficial than harmful to the members of our 
District Society. 

In our neighboring State of Pennsylvania, across the 
Delaware river, there are two first-class hospitals in the 
towns of Easton and South Bethlehem. The former 
receives considerable financial support from Phillipsburg, 
just opposite Easton, in this county, and, accordingly, 
many indigent and other patients go there for treatment. 
A few persons go to the South Bethlehem hospital, about 
twelve miles up the Lehigh river ; but, owing to the 
nearness of the Easton hospital, the great majority of the 
patients are treated in that institution ; but upon the 
whole, these hospitals are more beneficial to the medical 



REPORTS OF DISTRICT SOCIETIES. 249 

fraternity of our county, than otherwise, as they receive 
and treat, as a rule, a class of patients in whom there is 
no " revenue " for the medical practitioner on this side 
of the Delaware river. 

During the past month there has been quite an epi- 
demic of scarlet fever in the Third and Fifth Wards of 
Phillipsburg, complicated with diphtheritic trouble, but 
few fatal cases. 

Dr. G. W. Cummins, of Belvidere reports an epidemic 
of inflammation of the middle-ear and the frontal and other 
sinuses of the head, accompanying the " grippe.*' He 
also reports that lobar pneumonia has been very preva- 
lent, and for the past three months there has been more 
sickness than for many years. 

Dr. J. M. Reese reports a case of tetanus from the toy 
pistol, and one of hydrophobia, both fatal. 

I send herewith an obituary notice of John S. Cook, 
M.D., a past-State President, and a Fellow, and an 
excellent paper by G. W. Cummins, M.D., of Belvidere. 

J. H. GRIFFITH, Reporter, 
Phillipsburg, N. J., June i, 1900. 



CONTENTS. 



4-»-* 

PAGE. 

OFFICERS 4 

FELLOWS 5 

HONORARY MEMBERS 7 

PERMANENT DELEGATES 8 

MEMBERS OF DISTRICT SOCIETIES 11 

SUMMARY OF MEMBERS..' 27 

MINUTES 29 

APPENDIX TO THE MINUTES— 

Report of Committee on Business 53 

Report of Treasurer 54 

Report of Corresponding Secretary 55 

Report of Recording Secretary 55 

Report of the Standing Committee » 58 

Report on " Progress in Rhinology and Laryngology"... 62 

Report on "Progress in Bacteriology" 70 

Address of the Third Vice-President. Typhoid Fever; 
Its Relation to Water Supplies, with Observations 

Concerning its Treatment," by E. L. B. Godfrey, M.D. 73 

Address of the President, by Luther M. Halsey, M.D 83 

"Progress in Medicine," by D. Benjamin, M.D 104 

"Progress in State Medicine," by Henry Mitchell, M.D 109 

Report of Committee on Medical Inspection of Schools.. 117 

Report of Committee on Abuse of Medical Charity 121 

Report of Committee on Entertainment of American 

Medical Association 122 

Essay, "Hydrophobia," by Alonzo I. Hunt, M.D 125 

Essay, "Hydrophobia; with Some Experimental Researches 

on its Pathology," by Frederick Randolph Bailey, M.D.... 147 

Report on " Progress in Surgery," by Charles Young, M.D. 163 

IN MEMORIAM 176 

OBITUARIES— 

DiLLWYN Parrish Pancoast, M.D 181 

Benjamin S. Lewis, M.D 182 

Hamilton Mailly, M.D 182 

Charles Harrison Winans, M.D 184 

William Glatzmeyer, M.D 186 

Samuel Hayes Pennington, M.D 186 

Francis Eugene Noble, M.D 189 



252 CONTENTS. 

PAGE. 

H. C. CUNNEELY, M.D 189 

Charles H. Voorhees, M.D 190 

Lloyd Wilbur, M.D 190 

Dillon Drake, M.D 192 

Albert De Mee Jousset, M.D 193 

JosiAH Reeve, M.D 193 

Irwin Fisher, M.D 194 

Joseph P. Couse, M.D 19S 

Thomas Jefferson Jackson, M.D 196 

T. W. Harris, M.D 196 

John S. Cook, M.D 197 

REPORTS OF DISTRICT SOCIETIES- 
ATLANTIC COUNTY, Report by Emery Marvel. M.D 19- 

CAMDEN COUNTY, Report by John G. Doron, M.D 200 

CUMBERLAND COUNTY, Report by L. L. Hand, M.D 217 

ESSEX COUNTY, Report by W. S. Disbrow, M.D 220 

GLOUCESTER COUNTY, Report by William Brewer, M.D 224 

HUDSON COUNTY, Report by Henry H. Burnette, M.D 226 

MERCER COUNTY, Report by J. Franklin Chattin, M.D 235 

MONMOUTH COUNTY, Report by W. U. Kurtz, M.D 239 

MORRIS COUNTY, Report by E. P. Cooper, M.D 240 

PASSAIC COUNTY, Report by John R. Merrill, M.D 240 

SOMERSET COUNTY, Report by J. Henry Buchanan, M.D 246 

UNION COUNTY, Report by R. B. Whitehead, M.D 247 

WARREN COUNTY, Report by J. H. Griffith, M.D 248 



The Medical Society of New Jersey does not hold 
itself responsible for the sentiments expressed by the 
authors of papers; nor for the reports of clinical cases 
furnished by the reporters of the District Societies. — 
Transactions i8y6, page j8. 



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